Breast cancer surgery may include surgery to remove cancer from the breast and lymph nodes from under the arm.
Breast Conserving Therapy
This therapy involves removing the primary cancer from the breast (also called a "lumpectomy," "wide excision," "partial mastectomy," or "quadrantectomy") while leaving the rest of the breast intact.
Breast conserving surgery involves removing the primary cancer from the breast (also called a "lumpectomy," "wide excision," "partial mastectomy," or "quadrantectomy") with a margin of normal tissue while leaving the rest of the breast intact. Breast conserving therapy is usually a combination of surgery to remove the cancer followed by radiation to the breast.
At the U-M Rogel Cancer Center, East Ann Arbor Ambulatory Surgery Center, and the Brighton Center for Specialty Care, tissue samples may be examined microscopically while the patient is still under anesthesia. Based on the lab's findings, surgeons can decide to remove additional tissue during the same surgery. This approach reduces the likelihood of additional surgery, improves patient care and outcomes, and reduces the overall cost of care.
Mastectomy - removal of the entire breast - may be a better treatment option for some women.
Doctors have found that if the primary tumor cannot be completely removed, the risk of having the cancer come back in the breast is unacceptably high, even with radiation after the surgery. Thus, women with large tumors or those with multiple sites of cancer in the same breast may be recommended to undergo a mastectomy.
University of Michigan Health Rogel Cancer Center, surgical oncologist, Dr. Melissa Pilewskie, sits down and talks to us about surgical options for breast cancer. The focus being on helping women determine whether lumpectomy or mastectomy is appropriate for them and their type of breast cancer.
The Cancer Aware podcast is part of the Michigan Medicine Podcast Network.
This is surgery to rebuild the breast shape - may be considered at the time a mastectomy is done (immediate reconstruction) or after finishing treatments in the future (delayed reconstruction). The reconstructed breast may be made with the patient's own (non-breast) tissue or by using implants filled with saline or silicone gel.
In addition, some patients undergoing lumpectomy for a large tumor or those with large breast size, may be candidates for a different type of breast reconstruction to minimize a defect from the surgery, called oncoplastic surgery.
Learn more about the extensive services available to you by visiting the Breast Reconstruction Surgery website.
Lymph Node Surgery
At the time of primary breast surgery, most women have evaluation of their axillary nodes, to determine whether the cancer has spread there. This evaluation helps to determine the stage and treatment plan.
Sentinel Lymph Node Biopsy
When the lymph nodes feel normal by physical exam, a procedure called a sentinel lymph node biopsy (SLNB) is performed to evaluate whether microscopic breast cancer cells have spread to the lymph nodes. A SLNB involves removing the first lymph nodes that drains the breast, called the sentinel nodes, and evaluating those for cancer. If the sentinel node is cancer-free, it is unlikely that any of the other axillary lymph nodes are positive.
Axillary Lymph Node Dissection
In some situations where breast cancer cells have travelled to the lymph nodes, it is necessary to remove the surrounding axillary lymph nodes in a procedure called an axillary lymph node dissection (ALND). This allows doctors to determine how many lymph nodes are affected.
The number of lymph nodes involved will help determine whether chemotherapy is recommended. Most women who have positive axillary lymph nodes will also receive radiation therapy to that area after surgery, while those with negative axillary lymph nodes may not.
Removing axillary lymph nodes can lead to swelling in the arm, a condition called lymphedema.
The U-M Rogel Cancer Center offers monthly classes with physical and occupational therapists to help patients prevent or manage lymphedema.
Even if the doctor removes all the cancer that can be seen at the time of the surgery, some patients may be given radiation therapy, chemotherapy or hormone therapy after surgery to kill any cancer cells that are left. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.