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Breast Cancer: What You Need to Know About Surgery

Breast Cancer: What You Need to Know About Surgery

“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 Monday through Friday, every day for 6˝ 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 percent) but they are identical for lumpectomy followed by radiation as compared to mastectomy (6-8 percent). So, chin up! Most women don’t have to lose their breast to save their life.

But there are reasons women 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.

My intent is to overcome Breast Cancer

For more breast cancer articles, go to Intent.com. Intent is a new site providing content and a community for who you aspire to be–personally, socially and globally.

Read more: Health, Cancer, , , , ,

By Kristi Funk, M.D., from Intent

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8 comments

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1:16PM PDT on Apr 21, 2013

Thanks

9:44AM PST on Feb 8, 2013

Thank you.

10:34AM PDT on Sep 2, 2010

There is some serious research out there on flax hull lignans and breast cancer. I work for one of the organizations that does research (I'll remain nameless) and see testimonials come across my desk all the time. I encourage you to research it. Especially research the flax muffin study done in Canada. Almost everyone with cancer who had a muffin with concentrated flax lignans had reductions in their cancer if it didn't disappear all together. I like to purchase my lignans from a company called flax lignan health, as they use the same lignans from the studies. I really encourage people with breast cancer to research this all natural extract from the shell of flax seed. It isn't an estrogen, it's a phytoestrogen and only acts as an estrogen and causes cancer cells to self-destruct. Research a Dr. Stephen Martin -phD in Immunology from Berkley. He claims that flax lignans cause apostosis in cancer cells.

2:53AM PDT on Jun 15, 2009

thanks...
Kabin
Konteyner

5:39AM PDT on Oct 17, 2008

Diagnosed in Jan '93 I explored alternatives and founded www.annieappleseedproject.org providing information on all the OTHER possibilities. Make a more informed decision by learning options. There are complementary treatments to reduce unwanted (side) effects of conventional treatment - like acupuncture, as well as natural and integrative approaches. Find out more FIRST!

12:22AM PDT on Oct 17, 2008

I live in the South of England. .... and a 4 year survivor. i have had a double mast. with double reconstruction. and a superb new nipple made form bits of my leg! ALL on our NHS.
Please do not use words like "Chin up!" as in your 10 paragraph, hugely insensitve!
Chop it all and get rid are the best ways to feel confident at this most harrowing time. i trust you have not actually heard those words when applied to you personally? I would refer people to the breast cancer.org and breast cancer care websites if i were you!

7:50PM PDT on Oct 16, 2008

Did you know that doing nothing--as in no chemo, no radiation, no surgery-- will not make a bit of difference (well maybe a few days or month) in life span of a cancer patient? Statistics are quite manipulated. While not an outright lie, numbers can turn one out of two people into 50% for example. Well, maybe that other person also had other issues like being an ex-smoker or they eat a poor diet. Why is a person "cured" if they survive 5 years? What happens after that? I'm going to write an article about this numbers game with a few other solutions as well. Email me if you want the link and give me a day or two to do the work!

1:46PM PDT on Oct 16, 2008

I was recently diagnoised with breast cancer and opted for a mastectomy because i did not want radiation. My cancer was stage II because 2 of my sentinel nodes had cancer. Onocologists want me to have chemo but I'm opting to take concentrated flax hull lignans, which according to the Health Sciences Institute cures all types of cancer including bone, pancreatic, and lung. It actually destroys tumors. I'm confident that it will keep my cancer from coming back!

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Disclaimer: The views expressed above are solely those of the author and may not reflect those of
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