Breast cancer surgery involves tissue removal for diagnostic purposes and control of cancer when a tumor has not yet metastasized. In cases of metastatic breast cancer, surgery may be performed in combination with other treatments, such as chemotherapy and radiation therapy.
Surgery targets specific areas and can be controlled so that a minimum of normal tissue is affected. Depending on the nature and extent of the suspected cancer, surgical options range from a breast biopsy for a small, localized tumor to radical mastectomy, which involves removing the entire breast.
Surgery: Breast Lumpectomy and Biopsy
Biopsies are microsurgeries in which a sample of suspicious tissue is obtained and analyzed for signs of cancer. Doctors choose the type of biopsy to perform based on tumor characteristics, location and whether they can feel it by touch. The four types of biopsies include:
- Axillary node dissection removes a layer of fat containing several lymph nodes from the armpit region. The nodes are then examined to assess how far the cancer has spread.
- Fine needle aspiration (FNA) is used to remove fluid and tissue from a targeted lump in a single procedure or series of procedures. For very small lumps, a “stereotactic” approach can be applied using computer-based imaging to enhance guidance of the biopsy needle. A core biopsy may be used if the surgeon wants a larger sample of tissue. The core biopsy can provide a more accurate diagnosis than fine needle aspiration. Another option is vacuum-assisted breast biopsy, which can remove large tissue samples with only a small incision.
- Open excisional (lumpectomy) is a localized open surgical procedure used for breast lump removal. The targeted breast tissue is cut away in a single piece and removed through a small incision. Analysis of the tissue will confirm the lump to be a cyst, or a benign or malignant tumor.
- Sentinel node biopsy involves the selective removal of the first lymph node in the armpit (“axillary”) region that receives lymph fluid from the breast. The first node is removed due to the higher probability that cancer cells will accumulate there before metastasizing to other tissues. Sentinel node biopsy is helpful because analysis of nodal tissue will indicate if cancer has reached the armpit, and will help determine if additional treatment is necessary.
Types of Mastectomy Surgery
Radical mastectomy may be recommended for patients with Stage IV metastatic breast cancer when malignant cells have migrated. Doctors may perform a partial mastectomy in early metastasis when a high probability of removing all of the cancer exists.
Sometimes women who are most at risk choose preventive surgery–or a “prophylactic mastectomy”–in the hope of reducing the probability of getting breast cancer. The most severe option is to have radical mastectomy followed by breast reconstruction. A less radical option is subcutaneous prophylactic mastectomy, which removes much of the breast tissue but keeps the nipples and areola intact. Prophylactic mastectomy is a controversial treatment option, and is not universally supported by the medical profession.
The American Cancer Society. Breast cancer facts and figures 2009-2010. Retrieved October 20, 2010, from http://www.cancer.org/acs/groups/content/@nho/documents/document/f861009final90809pdf.pdf
National Cancer Institute. Treatment options overview. Retrieved October 20, 2010, from http://www.cancer.gov/cancertopics/pdq/treatment/breast/Patient/page5