There are two main types of breast cancer surgery. They are:
- surgery to remove the cancerous lump (tumour), known as breast-conserving surgery
- surgery to remove the whole breast, which is called a mastectomy
In many cases, a mastectomy can be followed by reconstructive surgery to try to recreate a bulge to replace the breast that was removed.
Studies have shown that breast-conserving surgery followed by radiotherapy is as successful as total mastectomy at treating early-stage breast cancer.
Breast-conserving surgery ranges from a lumpectomy or wide local excision, where just the tumour and a little surrounding breast tissue is removed, to a partial mastectomy or quadrantectomy, where up to a quarter of the breast is removed.
If you have breast-conserving surgery, the amount of breast tissue you have removed will depend on:
- the type of cancer you have
- the size of the tumour and where it is in your breast
- the amount of surrounding tissue that needs to be removed
- the size of your breasts
Your surgeon will always remove an area of healthy breast tissue around the cancer, which will be tested for traces of cancer. If there's no cancer present in the healthy tissue, there's less chance that the cancer will reoccur. If cancer cells are found in the surrounding tissue, more tissue may need to be removed from your breast.
After having breast-conserving surgery, you will usually be offered radiotherapy to destroy any remaining cancer cells.
A mastectomy is the removal of all the breast tissue, including the nipple. If there are no obvious signs that the cancer has spread to your lymph nodes, you may have a mastectomy, where your breast is removed, along with a sentinel lymph node biopsy (see below).
If the cancer has spread to your lymph nodes, you will probably need more extensive removal (clearance) of lymph nodes from the axilla (under your arm).
Breast reconstruction is surgery to make a new breast shape that looks as much as possible like your other breast. Reconstruction can be carried out at the same time as a mastectomy (immediate reconstruction), or it can be carried out later (delayed reconstruction). It can be done either by inserting a breast implant or by using tissue from another part of your body to create a new breast.
Lymph node surgery
To find out if the cancer has spread, a procedure called a sentinel lymph node biopsy may be carried out.
The sentinel lymph nodes are the first lymph nodes that the cancer cells reach if they spread. They're part of the lymph nodes under the arm (axillary lymph nodes). The position of the sentinel lymph nodes varies, so they're identified using a combination of a radioisotope and a blue dye.
The sentinel lymph nodes are examined in the laboratory to see if there are any cancer cells present. This provides a good indicator of whether the cancer has spread.
If there are cancer cells in the sentinel nodes, you may need further surgery to remove more lymph nodes from under the arm.
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