Different Types of Breast Cancer Surgeries
When you're making a decision about breast surgery, it helps to know the basics of your surgical options.
For women diagnosed with breast cancer, surgery is performed to treat the disease. Many options are available and whenever possible, women are offered a chance to have a lumpectomy (or breast-conserving surgery.) Below are the different surgery types that pertain to a breast cancer treatment protocol.
Biopsy
When a woman finds a lump in her breast, or a mammogram reveals a suspicious area, a biopsy is performed to determine whether cancer is the cause. A surgeon performs a biopsy to remove a tissue sample or the entire lump, which is then reviewed under a microscope. Breast biopsies may also be done with a needle, depending on the type and location of the area in question.
Lumpectomy (Breast-Conserving)
Lumpectomy is surgery to remove a breast tumor and some of the surrounding tissue. This surgery is performed in hospital under local anesthesia and a mild sedative, and typically does not require an overnight stay. Lumpectomy is appropriate for women who have single tumors under 4 cm, with surrounding margins of tissue that are free of cancerous cells. When followed by radiation, lumpectomy is as effective as mastectomy.
Mastectomy (Breast Removal)
Mastectomy removes the entire breast, either to treat breast cancer or to prevent it in high-risk individuals. Mastectomy is recommended for women whose cancers cannot be completely removed by lumpectomy, who cannot tolerate radiation, or who have two or more areas of cancer in different areas of the same breast. This surgery is performed under general anesthesia and patients usually spend one night in hospital.
Total or simple mastectomy:
A total mastectomy removes the entire breast, including the nipple, areola, skin and the fatty tissue underneath the skin. Total mastectomy is appropriate for women with DCIS and those who choose prophylactic mastectomy.
Modified radical mastectomy:
A modified radical mastectomy removes the entire breast, including the nipple, areola, skin and the fatty tissue underneath the skin, and some underarm lymph nodes. Currently the most commonly performed mastectomy, modified radical mastectomy is recommended when invasive cancer is present.
Radical mastectomy:
A radical mastectomy removes the entire breast, all underarm lymph nodes and the chest muscle. Considered standard care for breast cancer years ago, this surgery is used infrequently now in developed countries.
Reconstruction
After mastectomy, women may choose to wear prostheses or not, or have their breasts surgically reconstructed.
Skin-sparing mastectomy:
When reconstruction is performed immediately with mastectomy, the nipple and areola are typically removed along with the breast tissue, but most of the breast skin is kept to hold an implant or a flap of tissue from elsewhere on the body. Women who have immediate reconstruction need a longer hospital stay (usually a few days) than with mastectomy alone, and a longer recovery (between 3-6 weeks), depending on the type of reconstruction.
Women who are not at high risk for breast cancer or recurrent cancer in the nipple/areolar area may be candidates for one of the following skin-sparing mastectomy procedures:
Areolar-sparing mastectomy: preserves the areola and the remaining breast skin, but removes the nipple.
Nipple-sparing mastectomy: preserves the nipple and remaining breast skin, but removes the areola.
Areolar/nipple-sparing mastectomy: removes breast tissue through an incision in the fold under the breast, preserving the nipple and areola. This is also referred to as subcutaneous mastectomy.
by Kathy Steligo
