Treatment Options: Surgery

Surgery has an important role in the treatment of patients with breast cancer. Most women can choose between breast-conserving surgery (lumpectomy with radiation therapy) or removal of the breast (mastectomy). Clinical trials have proven that both options provide the same long-term survival rates for most types of early breast cancer. However, neither option guarantees that cancer will not recur. Whichever choice you make, you will need close medical followup for the rest of your life.

Breast Conserving Surgery

LUMPECTOMY

The surgeon removes the breast cancer and some normal tissue around it (in order to get clear margins). This procedure usually results in removing all the cancer, while leaving you with a breast that looks much the same as it did before surgery. Usually, the surgeon also takes out some of the lymph nodes under the arm to find out if the cancer has spread. Women who have lumpectomies almost always have radiation therapy as well. Radiation therapy is used to destroy any cancer cells that may not have been removed by surgery.

PARTIAL or SEGMENTAL MASTECTOMY

Depending on the size and location of the cancer, this surgery can conserve much of the breast. The surgeon removes the cancer, some of the breast tissue, the lining over the chest muscles below the tumor, and usually some of the lymph nodes under the arm. In most cases, radiation therapy follows.

Mastectomy

TOTAL (or SIMPLE) MASTECTOMY

The surgeon removes the entire breast. Some lymph nodes under the arm may be removed, also.

MODIFIED RADICAL MASTECTOMY

The surgeon removes the breast, some of the lymph nodes under the arm, and the lining over the chest muscles, and sometimes part of the chest wall muscles.

RADICAL MASTECTOMY

The surgeon removes the breast, chest muscles, and all the lymph nodes under the arm. This was the standard operation for many years, but it is used now only when a tumor has spread to the chest muscles.

A mastectomy may be recommended when:
* Cancer is found in more than one part of the breast.
* The breast is small or shaped so that a lumpectomy would leave little breast tissue or a very deformed breast.
* A woman chooses not to have radiation therapy.
* A woman prefers a mastectomy.

POSSIBLE PROBLEMS: As in any kind of surgery, there is a risk of infection, poor wound healing, bleeding, or a reaction to the anesthesia used in surgery. There may be a collection of fluid under the skin; or tingling, numbness, stiffness, weakness, or swelling of the arm. (See lymphedema.) Physical therapy and exercise can help to restore arm movement and strength.

After a mastectomy, a woman may choose to:
* Wear a breast form, called a prosthesis, that fits in her bra. To find stores that have breast forms and fitters, talk with your doctor, nurse, or a volunteer from the American Cancer Society Reach for Recovery program or other breast cancer organization, or other women who have had breast cancer.
* Have her breast reconstructed by a plastic surgeon.
* Do neither.

Some health insurance plans pay for all or part of the costs of a prosthesis or for breast reconstruction. However, there may be health insurance rules about where a woman can have breast reconstruction surgery or where to buy a prosthesis. For details about your health plan coverage, contact your insurance company.