Surgery is the cornerstone of the treatment of breast cancer. It is needed to remove the cancer and evaluate for spread of the disease to lymph nodes in the area. Testing on the tissues removed is done to determine the size and cell type of the tumor and if there are cancer cells that have spread to the lymph nodes. Results of these tests help determine if the patient will need additional treatment.
The two surgical options are lumpectomy or mastectomy.
A lumpectomy — also known as a partial or segmental mastectomy — is a breast-conserving procedure in which the surgeon removes the tumor and a rim of normal breast tissue around it. The goal is to have a cosmetically acceptable breast after surgery. A lumpectomy is usually an outpatient procedure requiring no overnight hospital stay. Radiation therapy is almost always recommended after a lumpectomy.
A mastectomy — also known as a simple or total mastectomy — is a procedure in which the entire breast is removed. A mastectomy commonly requires an overnight hospital stay. The patient usually is sent home with drains in place that are removed in the surgeon's office a week or so later. Activities are somewhat limited for that time. Radiation therapy is usually not recommended but might be used in certain circumstances.
Before a mastectomy, a patient is asked to consider breast reconstruction. In many cases, breast reconstructive surgery may begin at the time of the mastectomy.
Evaluation of adjacent axillary (underarm) lymph nodes is needed in almost all cases of invasive breast cancer regardless of the type of surgery performed. This is most commonly achieved with a sentinel lymph node biopsy. This procedure uses a dye or isotope that travels to the lymph nodes to identify possible problems. There usually are one to three nodes identified. They are evaluated by pathology. In some cases additional lymph nodes will need to be removed. This is called an axillary dissection.
After the operation, the patient is examined in the surgeon's office, and the findings from the pathology evaluation of the tissue is discussed. Recommendations for additional treatment, such as chemotherapy or radiation therapy, are made by consulting medical and radiation oncologists.