Under the Knife: What You Need to Know About Breast Surgery

Surgery -- whether lumpectomy or mastectomy -- is usually the first line of defense when a woman is diagnosed with breast cancer. Leading breast surgeon Dr. Kristi Funk shares what a woman needs to know about her surgical treatment options. 

By Kristi Funk, M.D.

"You have cancer." Three words -- and now, countless questions. Surgery is usually the first line of defense when it comes to treating breast cancer and it typically includes two parts: first, excising the cancer from the breast, and second, checking the lymph nodes in the armpit (axilla) to see if the cancer has spread. 

Here's some very good news: Cancer confined to the breast -- and yes, even when in lymph nodes -- is curable! When the cancer is very large, or we know it has spread to other organs, chemotherapy becomes the first choice to shrink the tumor. Surgery follows chemotherapy once the breast tumor has shrunk, and/or the cancer in other organs has disappeared. 

Here are some terms you should know that relate to breast surgery:
Lumpectomy: Surgery to remove cancer with a surrounding margin of healthy breast tissue in all directions around the cancer. With rare exception, everyone who has a lumpectomy for cancer receives radiation therapy to the breast afterwards. 

Mastectomy: Surgery to remove the entire breast, usually including the nipple and areola, but leaving the majority of overlying skin and underlying muscles. 

Sentinel Node Biopsy (SNB): The surgical removal of the first lymph node(s) in the armpit. This node(s) receives lymphatic drainage of the breast and can be analyzed microscopically to determine if cancer has spread beyond the breast. 

Complete Axillary Node Dissection (CAND): The surgical removal of all armpit lymph nodes when one or more nodes have cancer. Since the total number of nodes a woman has varies from 10 to 35, and you have hundreds in your body, you shouldn't miss these particular nodes. 

Lymphedema: A condition characterized by chronic arm swelling. This uncommon complication of CAND, which ranges from imperceptible/mild to debilitating, can occur after the removal of axillary lymph nodes when the lymph in the arm doesn't drain and backs up. 

Radiation: While this isn't a form of surgery, this treatment -- in which energy rays are delivered to the remaining breast tissue -- is common after surgery to essentially sterilize the breast cells and minimize the chances of a recurrence. The typical timeframe for radiation treatment is daily from Monday to Friday for 6 1/2 weeks (33 treatments), with each session lasting about 1 to 3 minutes. Brachytherapy, also called "accelerated partial breast irradiation", radiates only the tissue near the original cancer site, with as few as 10 5- to 7-minute treatments in five days. If you took 2,000 women with a cancer under 5 centimeters and divided them into three groups who receive either lumpectomy alone, lumpectomy followed by radiation, or mastectomy, who do you think has the highest chance of dying, and in whom has the cancer been likelier to return? 

Here's the surprising answer: The chances of dying are the same for all three groups. The chances that breast cancer comes back (what's called the recurrence rate) are highest for lumpectomy alone (40%) but they are identical for lumpectomy followed by radiation as compared to mastectomy (6-8%). In other words, most women don't have to lose their breast to save their life. 

But there are reasons a woman may opt for a mastectomy over a lumpectomy. Here are six common ones: 

1. She has a small breast and a large tumor. In cases where a lumpectomy would be deforming, a woman may choose a mastectomy with reconstruction because it would look much better. 

2. She has more than one cancer in different parts of the breast. 

3. She will not have radiation after lumpectomy, for any number of reasons, including distance from a treatment center, serious medical conditions (usually involving the heart or lung) that prohibit it, a physical handicap that limits radiation delivery, or a fear of radiation or radiation toxicity. 

4. She's already had radiation for a previous breast cancer in the same breast. Breast skin and tissue cannot handle a second round of radiation. 

5. She has a BRCA genetic mutation, or a strong family history of breast cancer. She may consider removing the other breast as well, even if it's healthy, to prevent a tumor. 

6. She simply doesn't want a mastectomy. 

Wishing you the "breast" of health always! 

Kristi Funk, M.D. is director of patient education and a surgical breast specialist at the Saul and Joyce Brandman Breast Center, A Project of Women's Guild, at Cedars-Sinai Medical Center, in Los Angeles. For more on Dr. Funk, go to www.pinklotusmedical.com 

For more breast cancer articles, go to www.intent.com

Copyright(c) 2008 Intent.com

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