Breast Cancer Surgery
When breast cancer is detected, breast cancer surgery is often a recommended first course of treatment. There are two main types of breast cancer surgery.
Lumpectomy is a breast-conserving surgery to remove cancer. This means your breast remains intact. If you are having a lumpectomy, you will likely have radiation therapy as well. After the surgery, you will be given home care instructions.
Your surgeon will make an incision to remove the tumor. You may have two incisions. One will be near the tumor site. The other may be under the arm, near the lymph nodes. A surrounding margin of normal tissue will also be taken.
Sentinel Node Biopsy
Cancer cells can travel beyond the breast to the lymph nodes. During surgery, the first lymph node or nodes that cancer cells could reach may be removed and screened in a procedure known as sentinel node biopsy.
If appropriate, more of the nodes are removed. If any nodes contain cancer, adjuvant therapy is often needed.
Recovering After Lumpectomy
You will wake up in the recovery room. You may have an IV (intravenous) line for fluids and medications. Pain medications will be given to you as needed. A nurse will check your temperature, pulse, and blood pressure. You should be up and walking soon after surgery. You will likely go home the same day.
If axillary lymph nodes were removed during surgery, you may have a soft plastic drain. This draws off fluid from around the incision. Be sure to empty the drain at least every eight hours, or as directed. The drain will be removed in your doctor’s office.
Call your doctor right away if you have any of the following:
- Bleeding that soaks through the dressing
- Cough or shortness of breath
- Fever of 101 or higher
- Increased pain, warmth, drainage, swelling, or redness at the incision or drain site
- Pain in the chest or calf
The most commonly done mastectomies are called “simple” and “modified radical.”
During these procedures, the chest muscle is not removed. As a result, arm strength remains. Keeping the chest muscle also makes reconstruction easier.
During a simple mastectomy, the breast tissue (lobules, ducts, and fatty tissue) and a strip of skin with the nipple are removed. This surgery often requires a hospital stay. Based on the results of surgery and any follow-up tests, further treatment may be needed.
Modified Radical Mastectomy
This type of mastectomy is usually done to treat invasive breast cancer. With a modified radical mastectomy, the breast tissue, a strip of skin with the nipple, and some of the axillary lymph nodes are removed.
Modified radical mastectomy almost always requires a hospital stay. Based on the results of surgery and follow-up tests, further treatment may be needed.
Checking the Lymph Nodes
Cancer cells can travel in the lymph fluid. During surgery, the first lymph node or nodes that cancer cells could reach may be removed and screened, a procedure known as sentinel node biopsy.
Sometimes all of the nodes are removed. If the nodes contain cancer, adjuvant therapy is often needed.
Recovering After Mastectomy
After surgery, you will wake up in the recovery room, where you will be closely watched. You may have an IV for medications and fluids. Once fully awake, you will be taken to your room, where you can have visitors. Expect to be up and walking soon after surgery.
A few days after surgery, your dressing will be removed. Looking at your scar for the first time may be hard. You may feel most at ease taking this step at home. You may want to be alone or you may want a friend to support you. Either way is OK. At first, try looking down rather than in the mirror.
The length of your hospital stay depends on the type of surgery you have. You will be given instructions to follow during recovery. Some women feel fine within a month. Others need a few more weeks. Take as much time as you need to adjust to the changes in your life and body.
Recovering After Breast Cancer Surgery
No matter what type of breast cancer surgery you have, your body needs time to recover. After surgery, you will receive information about helping your body heal:
- Be sure to empty your soft plastic drain at least every eight hours. Remove the plug and empty the contents into the container provided. Measure the amount of fluid as directed. Write it down to show your doctor. The drainage will decrease as you heal. The drains will be removed at the doctor’s office.
- Care for the dressing over your incision as directed. Ask how soon you can take a shower.
Stitches at the incision site may dissolve on their own, or they may be removed at your follow-up visit.
- Pain medications to help relieve any discomfort should be taken as directed.
- After surgery, you may be given a temporary prosthesis. It is a soft breast form that fits into a bra. Some women wear breast forms to help balance weight and avoid back strain. Other women wear them for appearance. Talk to your doctor if you want a prescription for a permanent prosthesis. You may wear it when your incision feels less tender and swollen.
Reconstruction can be done during or after a mastectomy.
There are two main types of breast reconstruction. One is the breast implant, where a sac of fluid is inserted during surgery to re-form the shape of the breast.
The other type of reconstruction uses your own tissue to rebuild the breast. With both types, a nipple and areola may be created during or after the procedure. If reconstruction is part of your breast cancer surgery plan, talk with your doctor to decide what type is best for you.
Reconstruction With Implants
Most breast implants are shells filled with fluid. To insert the implant, a small incision is made, often through the mastectomy scar. The implant is placed under your chest muscle.
Recovery may take three to six weeks, and you may have surgery later to create a nipple and areola. Surgery may also be needed to match your remaining breast to the reconstructed one. The reconstructed breast will probably feel firmer than your natural breast.
If you do not have enough muscle and skin to cover an implant, you may need a tissue expander. This is an empty implant shell that inflates as fluid is injected.
The expander is placed under the skin and muscle. Fluid is injected through a metal port. This happens about once a week. When the muscle and skin are stretched enough, the expander is replaced with an implant.
A flap reconstruction uses your own tissue to form the shape of a breast. There are two common procedures for flap reconstruction. You may be instructed to start physical therapy after reconstruction. This is to strengthen the muscles affected by surgery. Recovery may take six to eight weeks.
- TRAM Flap. The TRAM (transverse rectus abdominis myocutaneous) flap uses abdominal muscle, fat and skin. The new breast feels soft to the touch. A flap of skin and fat is removed from the lower part of the abdomen. One of the abdominal muscles is left attached to the flap. Then the flap is tunneled under the skin from the abdomen to the mastectomy site. There the flap is formed into the shape of a breast.
- LD Procedure. The LD (latissimus dorsi) procedure uses back muscle and fat, and is often combined with the use of an implant. The latissimus dorsi muscle is detached from the side of the body over the ribs. The muscle, fat, and skin are moved to the mastectomy site. There they are laid over an implant and secured in place. In many cases, this procedure is done through the mastectomy incision.
Innovators in Breast Cancer Care
Our physicians are leaders in the diagnosis and treatment of breast cancer, including breast cancer surgery:
- We introduced both stereotactic needle biopsy of breast lesions and sentinel lymph node biopsy to west Tennessee.
- We are the only clinic to offer Mammotome vacuum-assisted needle biopsy and removal of breast lesions in the office setting.
- We were the first to perform office-based, needle core biopsy of breast lesions, ultrasound-guided needle biopsy, and skin-sparing mastectomy with immediate reconstruction.
- We offer diagnosis and surgical treatment of breast lesions closely coordinated with medical and radiation oncology, as well as counseling with risk assessment and risk reduction.
- Our physicians are members of the American Society of Breast Surgeons and the American College of Surgeons Oncology Group.
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