The most common treatment for breast cancer is surgery. There are several different types of surgery:
Conservative surgery (breast-sparing surgery): This type of surgery aims to take away the cancer, while leaving behind as much healthy breast tissue as possible, ultimately leaving the breasts intact. To try to make sure that all the cancer has been removed the surgeon removes a border of healthy tissue around the tumor. This tissue is then sent to the pathologist, who inspects the healthy layer for signs of cancer cells. If the layer is clear of cancer it will be reported as a 'healthy margin' or 'clear margin'. If the layer is not a 'clear margin', you may require further surgery. The surgeon often removes the underarm lymph nodes as well, through a separate incision. This procedure is called an axillary lymph node dissection. It shows whether cancer cells have entered the lymphatic system. The picture illustrates the tissue removed during a conservative surgery.
Conservative surgery is sometimes also called Lumpectomy, or Wide local excision. In practice, these two are very similar to the conservative surgery. The surgeon removes the tumor, with a thin layer of healthy tissue around it. Lumpectomy is also used to describe an open biopsy. This is when the doctor does not know if the lump is cancer, and he/she must remove it in order to find out.
Segmentectomy (Quadrantectomy) is another form of conservative surgery, but is not performed as often as a lumpectomy. It resembles the wide local incision, but the surgeon removes more breast tissue. A segmentectomy removes approximately a quarter of the breast tissue, making the operation more noticeable than lumpectomy. Because the surgery is so noticeable breast reconstruction surgery is often an option.
After any of the above mentioned surgeries, patients usually undergo radiotherapy to make sure that there are no breast cancer cells left behind in the remaining breast tissue.
Mastectomy: For some women mastectomy is the more suitable treatment; the complete removing of the breast. Mastectomy is most suitable when:
- There is a large lump, particularly in a small breast.
- The lump is located in the middle of the breast.
- There is cancer in multiple areas of the breast.
- There are areas of DCIS in the rest of the breast.
As with conservative surgery, there are different types of mastectomy:
- Simple Mastectomy: also known as Total Mastectomy, this form only removes the breast tissue
- Radical Mastectomy: removes the breast tissue and chest wall muscles.
- Modified Radical Mastectomy: removes the breast and lymph nodes under the arm, leaves the major chest wall muscles intact.
Modified Radical Mastectomy
Once you have undergone a mastectomy, you may feel off balance, possibly even more so if you have large breasts. This imbalance may cause discomfort in your neck and back, as muscles will tense to cope with the imbalance. Also, the skin where your breast was removed may feel tighter than usual, and your arm and should muscles may feel stiff and weak. This will usually all go away with time. The doctor, nurse, therapist, often suggests exercises to regain the movement and strength in your muscles; this exercise will also help reduce the stiffness and pain.
The removing of the lymph nodes under the arm will slow down the flow of lymph fluid, which can cause build ups and swelling. This swelling is called lymphedema, and can develop right after surgery, but also months or even years later. The lymphs do not repair themselves, and do not grow back. There is also no known cure for lymphedema. Patients who develop lymphedema are often given a compression sleeve and glove, which they are supposed to wear every day. This compression sleeve helps against the swelling.