Evolution And Choice Of Breast Cancer Surgery
Understand about the types of breast cancer surgeries:
- Lumpectomy: Your tumour (lump) and a small amount of normal breast tissue
around the tumour was removed. - Mastectomy: Your whole breast was removed.
- Axillary lymph node dissection: Most (lower two thirds) of the lymph nodes
under your arm were removed to:1]check if the cancer spread from your breast to the lymph nodes under your arm 2]remove any cancer that may have spread to your lymph nodes. This reduces the risk of cancer coming back in armpit.
- Radical or modified radical mastectomy [RM/MRM]: this involves radical removal of breast with tumor in toto and axillary dissection as described above. In this surgery the contour and substance of the breast is lost. For reconstruction after such surgery one may choose doing skin sparing mastectomy [SSM] with reconstruction using flaps or prosthetic material or both.
- Breast conservation surgery[BCS]: this involved wide lumpectomy or removal of palpable mass in breast with certain amount of adjacent breast tissue and leaves behind the rest of breast. It also involves axillary dissection which means removal of lymph nodes along with fibrofatty tissues from armpit [where this cancer can spread or could have spread]. This may be followed by refashioning breast tissue for better form and shape to breast which is called oncoplasty. The reconstruction may as well involve usage of tissue from outside breasts like LD flap or prosthetic material like implants. Radiation to the remaining or conserved breast is a must after breast conservation surgery.
- Sentinel lymph node biopsy: This helps find out whether breast cancer has spread to lymph nodes under your arm. The sentinel nodes may be the first lymph nodes your tumour drains into. If the sentinel nodes have cancer cells, then more lymph nodes may need to be removed. And if sentinel node is negative on intraop frozen section assessment, further axillary dissection may not be warranted.
The best suitable surgery for any patient revolves around following factors:
- Tumour size and location
- Tumor to breast size ratio
- Patient’s desire for conservation or radical removal of breast
- Age, comorbidities, willingness and feasibility of radiation etc