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The Types Of Breast Cancer Surgery | Dr Sandra Krishnan

Sandra Krishnan • Oct 08, 2021

What are your options and what should your expectations be?

I remember my first Dragon Boat Race, as part of the Breast Cancer Institute team (the BCI) at Westmead, back in the day, was it 2007? The cold, sparkling water at Darling Harbour, exhilarating paddling with the BCI team, beautiful sun and sky, life putting on a show for us!! Dragon boating, we celebrated breast cancer patients, and we saluted their return to not 'just normal,' but better than normal. In this post, I discuss breast cancer surgery options and what they entail, post operative recovery and beyond.

Surgery for breast cancer has evolved tremendously through the ages. A simple dictum to remember is ‘less is more.’ The tumour is removed along with a cuff of tissue around it (margin) while preserving shape and size of the breast as far as possible. Principles of Oncoplastic Breast Surgery are used to combine oncological and plastic surgery techniques to achieve an outstanding oncological and aesthetic outcome.

Types of breast cancer surgery procedures depend on a few factors — volume of breast tissue excised, the site of the lesion, the spread, and your preference. A Sentinel Node biopsy procedure, to remove and test lymph nodes under the arm is also done. This helps the team plan further treatment after surgery.

Before having surgery for breast cancer, here is a brief explanation of the various procedures. There is a best option for you, discuss this in detail with your surgeon.

Lumpectomy

The cancer with normal breast tissue around it (margin) is removed, this procedure is also called wide local excision (WLE) or breast conserving surgery (BCS). A second procedure or a completion mastectomy may be needed if margins are not adequate. Radiotherapy to the breast is usually needed after the surgery in order to treat to the whole breast tissue.

Hence, this may not be a choice if someone can't or prefers not to have have radiation treatment. This procedure is usually not an option during pregnancy, if the cancer is large or has grown beyond the breast tissue.

Simple or total mastectomy for breast cancer surgery

Simple Mastectomy

The entire breast is removed, including the nipple. The lymph nodes are not excised.

This procedure is required when when the lymph glands are not involved, or the procedure is a risk reducing mastectomy.

Skin-Sparing Mastectomy

The skin of the nipple and areola is removed, and the whole breast is removed, but the rest of the skin is preserved so it can be used for breast reconstruction. This is not recommended if there are cancer cells close to skin, or there a plan for delayed breast reconstruction.

Sentinel Node biopsy or Axillary Lymph Node dissection

Lymph Node Surgery

A critical step in breast cancer surgery is determining lymph nodes status — to see if the cancer involves the lymph glands. This is usually done at the time of the first surgery, but can also be done later. There are two main procedures for lymph node surgery for breast cancer:

Axillary lymph node dissection (ALND). All the lymph nodes under the arm, about 10 to 20 lymph nodes are taken out. They are sent to the pathologist for cancer spread.

Sentinel lymph node biopsy. The first (sentinel) lymph node is identified and removed — where the breast cancer would most likely have spread first. We uses a lymphoscintigram (radioactive tracing) and a blue dye to accurately obtain the node/s. This surgery is much less likely to cause swelling in the arm (lymphoedema)

Modified Radical Mastectomy

In this operation, all breast tissue, including your nipple and lymph nodes in the armpit (axilla) are excised. The Pectoral muscles (chest muscles) are left intact, leaving a flat chest wall.

This might be the option when invasive breast cancer is diagnosed.

Radical Mastectomy (historical)

All of your breast tissue along with the nipple, lymph nodes in your armpit, and pectoral muscles under the breast are removed.

Today, this operation is hardly done. It is needed if the cancer has spread to chest muscles.

Breast Reconstruction

Women who get a mastectomy choose to get breast reconstruction either simultaneously (immediate) or later (delayed). Breast reconstruction can be created from the body’s own tissue, usually from the lower abdomen. Other methods are artificial implants.

Preparing for Breast Cancer Surgery

There are some important steps to get ready for this procedure.

A detailed medical history where information is provided to the medical team on any medications, including vitamins and supplements. Previous allergies or reactions to medications or surgical procedures in the past is documented.

Preexisting conditions can affect how the body responds to surgery, such as heart disease, diabetes, or high blood pressure. It is important for the team, including the anaesthetist to know this.

Blood transfusion is rarely required, but may be organised in case it becomes necessary.

As the date approaches, a series of tests are done for you including a Chest X-ray, ECG, and blood tests.These tests let your doctor know if your body is ready for the operation.

Specific tests depending on your procedure may be needed, a CT scan to check the size and location of your tumour. Lymphoscintigraphy for sentinel node biopsy.

Preoperative localisation procedure may be required, if the tumour is not felt, this may involve ultrasound and/or mammography and a hook wire in most centres.

How to deal with pain after Breast Cancer Surgery?

This procedure is remarkably painless for the most part, partly due to operating in existing planes and not cutting any muscle. The intensity and duration of post operative pain depends on extent of the procedure and whether a oran has been used. Intravenous or oral analgesics will be provided to keep as comfortable as possible. Gentle exercises to start mobilising, gradually increasing activities as the days go by, with adequate pain relief is recommended.

What is Breast Cancer Surgery recovery time?

The length of your stay in the hospital is variable. It depends on the type of procedure being done, how the body tolerates the operation which is dependent on the above and general health.

Lumpectomies can be day procedures. The recovery takes place in the day surgery centre and you will likely go home later the same day if everything is routine.

If you have a mastectomy or an axillary lymph node dissection, you will probably stay in the hospital for 1 or 2 nights.

What to expect after Breast Cancer Surgery?

A breast care nurse will be helping you along the journey, from before surgery to after care. You will be given information on wound care, exercises and return to daily activities, and a post operative appointment for a wound review and discussion of the pathology. This is when the most information becomes available, and a comprehensive treatment plan will be discussed.

Long term recovery from surgery is 100%. Donald McKenzie, a Canadian sports medicine specialist in February 1996 he started a dragon boat team for women with a history of breast cancer, which the women chose to name Abreast in a Boat. His paper concludes: ‘promoting health and raising breast cancer awareness that is driven by women with the disease. It reaches out to other women and offers them a message of hope and support. It is helping to change attitudes toward "life after breast cancer," and it encourages women to lead full and active lives. It is making a difference.’

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