Breast Surgery

Breast lumps

Finding a lump in your breast can be a frightening experience, and every year thousands of women consult their physicians with concerns about abnormal breast appearance, shape, or discharge. Fortunately, most breast lumps do not pose serious medical problems. In fact, eight out of 10 lumps turn out to be non-cancerous, or benign. In all cases, however, it is crucial that you see your physician as soon as possible to have the lump examined. The combination of regular self-examinations and sophisticated medical technology all aid in the early detection and successful treatment of breast cancer.

Breast cancer diagnosis

The first step in locating a lump is through a monthly self-examination. However, if the lump is small, you may not be able to detect it on your own. That is why it is so important to have regular mammograms, or chest x-rays, to check for any breast lumps or abnormalities.

There are a number of tests your doctor may conduct to help determine your risk of breast cancer, including a discussion of your medical and family histories, a physical examination, a mammogram, an ultrasound (which allows your doctor to distinguish between solid lumps and fluid-filled cysts), and a biopsy.

A biopsy involves removing a sample of breast tissue to examine, usually under a microscope, for the presence of cancer. Your doctor will either perform a needle biopsy or an open biopsy to determine whether your lump is cancerous or benign. There are two types of needle biopsies: a fine needle aspiration biopsy and a stereotactic (x-ray guided) core needle biopsy. Surgery involves the removal of small amounts of tissue from a lump, but an aspiration biopsy only removes a few cells, while a stereotactic biopsy removes a small, solid core of tissue. A needle biopsy is an outpatient procedure and, depending on the type, takes only a few minutes (aspiration biopsy) or less than an hour (stereotactic).

An open biopsy involves the removal of all or a portion of your breast lump to examine under a microscope. You will discuss beforehand with your surgeon whether you want to undergo a "one-step" biopsy, which combines the diagnosis with treatment, or a "two-step" procedure, which involves a separate biopsy and treatment. With an open biopsy, your surgeon will make every effort to create the surgical incision along the contour of the breast, to minimize any scarring. He will then remove either all or a portion of the lump, and stitch the incision closed. The tissue will then be examined under a microscope by a pathologist to determine:

  • The presence of cancer
  • Where it came from
  • The grade (1-4) of the cancer (a grade of 1 means the cancer is mildly aggressive, while a grade of 4 constitutes highly aggressive)

After the biopsy, your surgeon will be able to determine whether your lump is benign or malignant and discuss with you an appropriate treatment.

Sentinel lymph node biopsy

Sometimes, cancer can spread to the body's lymphatic system, which is a major component of the immune system and aids in the removal of excess fluid and the production of immune cells. The sentinel lymph node is the first lymph node to which cancer is likely to spread. In a sentinel lymph node biopsy, this lymph node is removed and examined under a microscope. This procedure allows your physician to look for the presence of cancer cells and determine its stage.

Benign and malignant breast lump

If a lump is benign, it is non-cancerous. Although this is always wonderful news, you should still be sure to schedule regular follow-up appointments and conduct monthly self-examinations.

If a lump is malignant, it is cancerous, and you will need to undergo treatment to eradicate all traces of the cancer. This reality may be difficult to face, and it may take you some time to fully come to terms with your diagnosis. It is important to surround yourself with family and friends during this time, and to express any questions and concerns you have to your physician. Remember: breast cancer is treatable, especially if it is caught early, and there is a strong coalition of breast cancer survivors across the country to offer you support.

Breast surgery

Breast cancer can be treated in a number of ways, with more effective treatment options available today than ever before. The type of treatment you choose will depend on a number of factors, many of them personal. In particular, the choice between a lumpectomy (the removal of a lump and some breast tissue) and a mastectomy (the total removal of the breast) can be very emotionally draining. It is important that you understand the benefits and drawbacks of each before making your decision.

Lumpectomy

A lumpectomy is a two-stage process that preserves your breast while removing a cancerous lump as well as some of the healthy tissue surrounding it. If you have already had an open biopsy, you may not need to have additional surgery on your breast, but in both cases, your surgeon may make a second incision under your arm to remove some of the nearby (auxiliary) lymph nodes, a process called auxiliary node dissection.

In most cases, your surgeon will recommend radiation therapy following a lumpectomy to eradicate any remaining cancer cells in your breast or lymph nodes. Radiation therapy usually takes place three to four weeks after surgery. The drawbacks of radiation therapy include the amount of time involved (a five-to-six week commitment), and potential side effects such as tightness or numbness under the arm, fatigue, and loss of sensation in the breast. Other forms of therapy your doctor may recommend include chemotherapy and hormonal therapy.

Mastectomy

There are five types of mastectomy surgeries. A modified radical mastectomy is a less-extensive version of the radical mastectomy, which was once the standard treatment for women with breast cancer. Whereas a radical mastectomy removes the breast, chest muscle, lymph nodes, and some additional fat and skin, a modified radical mastectomy does not remove the chest muscle. This not only preserves your arm strength and shortens your recovery time, it also allows you the choice of undergoing breast reconstruction.

Other forms of mastectomy include a simple mastectomy, which leaves the auxiliary lymph nodes intact, a skin-sparing mastectomy, which minimizes scarring and allows for quicker breast reconstruction, and a subcutaneous (nipple-sparing) mastectomy, which leaves the skin, nipple, and areola intact. The drawbacks of a mastectomy are primarily psychological, as losing one's breast can be very traumatic and provide a constant reminder of the experience. In return, however, a mastectomy serves as an extremely effective treatment.

Your surgeon may also recommend chemotherapy or hormonal therapy following surgery, depending on your type of cancer.

After breast surgery

  • You may spend several days in the hospital following a mastectomy (the average stay is three days).
  • There will be a drain at the site of your mastectomy or under your arm to collect residual fluid. You may experience mild pain, swelling, and discomfort at the mastectomy site, for which you will be given pain medication.
  • You should be able to resume your normal activities within a few days after your hospital stay, but it will take several weeks for you to fully recover.

First and foremost, you will want to continue giving yourself monthly breast exams to check for any changes, either in your breast or chest wall. Your surgeon will recommend a regular check up and mammogram schedule to monitor your recovery.

You will want to keep yourself as healthy and active as possible and, if you have undergone a mastectomy, exercise your arm to restore its range of motion. Also, be sure to avoid injuries on the side of your body affected by surgery, as you are more prone to infection in this area.

Getting your life back to normal after surgery can take a long time, but your success will be greatly aided by the support of your family, friends, and/or partner. If you are considering breast reconstruction surgery, be sure to talk to your surgeon; he or she can help you decide which method of restorative surgery is right for you.

It is possible to have reconstructive surgery started at the same time as your mastectomy, but many women wait months or even years before choosing to do so. You may also choose to wear a prosthetic breast, or none at all. Ultimately, your choice should depend on what makes you feel comfortable, confident, and healthy.

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