Breast Cancer Surgery

What is Breast Cancer Surgery?

Breast cancer surgery is a key treatment method designed to remove cancerous tissues while preserving as much healthy breast tissue as possible. It can be performed alone or as part of a comprehensive treatment plan that includes chemotherapy, radiation, or targeted therapy, depending on the cancer's stage and biological characteristics.

 

Phase 1: Preoperative Evaluation

Before deciding on surgery, a comprehensive assessment is conducted, including:

• Determining the size and exact location of the tumor within the breast
• Assessing whether the tumor is localized or has spread
• Evaluating the lymph nodes under the arm (axillary lymph nodes)
• Reviewing biopsy results to identify the type of cancer
• Assessing the patient’s overall health condition

Based on these findings, the medical team determines the most appropriate surgical approach.

 

Types of Breast Cancer Surgery

1. Lumpectomy (Breast-Conserving Surgery)

This procedure involves removing the tumor along with a small margin of surrounding healthy tissue while preserving the rest of the breast. It is usually followed by radiation therapy to eliminate any remaining cancer cells.

This option is most suitable for early-stage cases where the tumor is small and localized.

 

. Mastectomy

This involves the complete removal of breast tissue and may sometimes include the skin or nipple, depending on the case. It is typically recommended for larger tumors, multiple tumor sites, or certain preventive situations.

 

. Skin-Sparing or Nipple-Sparing Mastectomy

These advanced techniques aim to improve cosmetic outcomes by preserving the breast skin and/or nipple while removing the underlying breast tissue. This approach facilitates better reconstruction results.

 

. Lymph Node Surgery

This includes:

• Sentinel Lymph Node Biopsy: To determine whether cancer has spread to the lymph nodes
• Axillary Lymph Node Dissection: Performed if cancer spread is confirmed

 

. Breast Reconstruction

Reconstruction can be performed either immediately during the same surgery or at a later stage, using:

• Breast implants
• Or the patient’s own tissue (autologous reconstruction)

The goal is to restore the natural shape of the breast and support the patient’s psychological well-being.

 

Surgical Procedure Steps

• The surgery is performed under general anesthesia
• The surgeon removes the tumor or breast tissue according to the treatment plan
• The removed tissue is sent for pathological analysis to ensure complete cancer removal
• Temporary drainage tubes may be placed in some cases
• The procedure typically takes between 1 to 3 hours, depending on its complexity

 

Recovery After Surgery

• Hospital stay ranges from one day to several days
• Mild to moderate pain is expected and can be managed with medication
• Gradual return to normal daily activities over a few weeks
• Follow-up visits are required for wound care and removal of stitches or drains

 

Postoperative (Adjuvant) Therapy

After surgery, additional treatments may be required, including:

• Radiation therapy
• Chemotherapy
• Hormonal therapy
• Targeted therapy

These treatments aim to reduce the risk of cancer recurrence and improve long-term outcomes.

Symptoms of Breast Cancer That May Require Surgery

• A lump or abnormal mass in the breast or underarm.
• Changes in breast shape or size.
• Unusual nipple discharge, especially if bloody.
• Redness, dimpling, or skin texture changes (similar to orange peel).
• Persistent breast pain not related to the menstrual cycle.
• Nipple inversion or retraction.

Causes of Breast Cancer

• Genetic and hereditary factors: Mutations in BRCA1 and BRCA2 genes increase the risk.
• Hormonal changes: High levels of estrogen and progesterone.
• Family history: A strong family history of breast cancer increases the likelihood of developing the disease.
• Aging: The risk increases with age, particularly after 50.
• Lifestyle factors: Smoking, lack of physical activity, obesity, and excessive alcohol consumption.

Diagnosis and Medical Examinations

To confirm the diagnosis and determine the need for surgery, doctors conduct several tests:

1. Mammogram (X-ray of the breast): Detects tumors or suspicious calcifications.
2. Breast ultrasound: Assesses the nature of detected lumps.
3. MRI scan: Provides detailed images of the breast to determine tumor size and spread.
4. Biopsy: Extracts a sample of the tumor for microscopic analysis to confirm cancer and determine its type.
5. Hormone receptor and HER2 testing: Identifies if the cancer is responsive to hormone therapy or targeted treatments.

Types of Breast Cancer Surgery

1. Lumpectomy (Breast-Conserving Surgery):

• Removes the cancerous tumor and a small margin of surrounding tissue.
• Commonly used for early-stage cancer and often followed by radiation therapy.

2. Mastectomy (Total Breast Removal):

• Removes the entire breast and is used for larger tumors or cases where recurrence risk is high.
• Types of mastectomy include:
  • Simple mastectomy: Removes the whole breast without lymph node removal.
  • Modified radical mastectomy: Removes the breast along with nearby lymph nodes.
  • Radical mastectomy: Removes the breast, lymph nodes, and chest muscles (rarely performed today).

3. Lymph Node Surgery:

• Removes lymph nodes under the arm to check if cancer has spread.
• Two techniques:
  • Sentinel lymph node biopsy: Removes only a few key lymph nodes to determine cancer spread.
  • Axillary lymph node dissection: Removes multiple lymph nodes if cancer is detected in the sentinel nodes.

4. Breast Reconstruction Surgery:

• Performed immediately after mastectomy or at a later stage.
• Uses implants or autologous tissue (tissue from another part of the body) to restore breast shape.

Post-Surgery Care and Additional Treatments

1. Recovery After Surgery:

• Rest and avoid strenuous activities for a few weeks.
• Proper wound care to prevent infections.
• Physical therapy exercises to restore shoulder movement after lymph node removal.

2. Additional Treatments After Surgery:

To prevent recurrence, additional therapies may be required:

• Radiation therapy: Targets remaining cancer cells after lumpectomy.
• Chemotherapy: Used before or after surgery to shrink tumors or prevent recurrence.
• Hormone therapy: Blocks estrogen and progesterone effects to prevent cancer recurrence in hormone-sensitive cases.
• Targeted therapy: Such as HER2-targeted drugs for specific breast cancer types.

Possible Complications of Breast Cancer Surgery

• Pain and swelling at the surgical site.
• Fluid buildup (seroma) under the skin.
• Stiffness or reduced arm mobility.
• Lymphedema (swelling in the arm) after lymph node removal.
• Changes in skin sensation or numbness around the breast.

Success Rate and Recovery Outlook

• Surgery is one of the most effective treatments for breast cancer, with high survival rates, especially when diagnosed early.
• Regular follow-ups and screenings help detect recurrence early.
• Lifestyle changes, such as maintaining a healthy diet and regular exercise, improve long-term outcomes.