Surgical Oncology – Breast

Cancer. It’s a word no one wants to hear. But after absorbing the diagnosis, it’s time to take action. In some cases, that action involves surgical removal of the cancerous tissue or tumor. Our physicians are highly skilled and experienced in providing surgical care to cancer patients. Although we surgically treat a variety of cancers, we have a particular emphasis on breast cancer research and treatment.

Surgical Oncology/Breast Procedures:

There are different options available to each patient with either cancer or breast disease. We will recommend the course of action that is most appropriate for your condition, general health and other factors. Many of these common procedures are outlined here to provide you with an overview of how each is performed, typical recuperation periods and other general information. This information should not be used as a substitute for talking openly with all medical professionals involved with your care.

Lumpectomy

Definition/Overview

A lumpectomy is a surgical procedure performed to remove a suspected malignant (cancerous) tumor or lump along with a small portion of the surrounding tissue from the breast. How much of the breast is removed during the procedure is dependent on the size and location of the lump. The characteristics of the specific cancer are also a factor when determining if a lumpectomy is appropriate. Women in the early stages of breast cancer are often considered good candidates for this procedure.

Procedure

Prior to a lumpectomy, the physician may have performed a fine-needle biopsy of the breast. If the mass cannot be located by touch, a wire-localization procedure will be performed, which involves inserting a fine wire and utilizing ultrasound to confirm the tumor’s location.

Either local or general anesthesia may be used, depending on the extent of the surgery. The surgeon will make an incision over the targeted malignancy and remove the tumor, along with a small layer of surrounding tissue. If necessary, the physician will make a separate incision near the underarm to sample or remove axillary lymph nodes, which are tested for cancerous cells. A drainage tube may be inserted during the surgery to remove fluids, and the wound is closed with dissolving stitches.

This procedure typically takes 1 to 3 hours. You will spend a short time in recovery, and most patients are able to go home the same day. Depending on the extent of the lumpectomy, many women can usually resume normal activities within 1 to 2 days.

Mastectomy

Definition/Overview

A mastectomy is a surgical procedure in which most or all of the breast tissue is removed, in order to treat breast cancer. There are several types:

Simple (Total) Mastectomy

The removal of all of the breast tissue, but none of the underlying muscle or lymph nodes.

Modified Radical Mastectomy

The removal of all of the breast tissue and lymph nodes on the same side of the body as the breast.

Radical (Halsted) Mastectomy

The removal of all of the breast tissue, the underlying muscle, and the lymph nodes on the same side of the body as the breast (rare).

Skin-sparing Mastectomy

The removal of the breast tissue, but breast skin is kept for immediate breast reconstruction.

Procedure

This procedure is performed under general anesthesia. The surgeon will make a curved incision (that follows the natural curve of your breast) closes to the area of the tumor. If the tumor can be seen and/or felt, she will remove the tumor as well as the ring of healthy tissue surrounding it. If it cannot be seen or felt, you will have a procedure before the surgery that will locate and mark the tumor by either use of a mammogram or ultrasound.

After the tumor has been removed, a drain may be placed to collect excess fluids. The incision will be closed.

The actual mastectomy procedure takes approximately two to three hours; however, if you have chosen to have reconstructive surgery at that time, the length of your surgery will increase. Depending on your circumstances, you may be able to return home the same day.

Needle Biopsy

Definition/Overview

A needle biopsy is a diagnostic procedure that involves taking a small sample of breast tissue from an area that appears suspicious from a mammogram.

Procedure

During this procedure, you will be given a local anesthetic to numb the area. The physician will use a special, hollow needle to extract cells from the suspicious area for further diagnosis.

This procedure is most often performed on tumors that can be felt through the skin, such as suspicious breast lumps and enlarged lymph nodes. Types of needle biopsies include:

Fine-needle Aspiration

A long, thin needle is inserted into the suspicious area and a syringe used to draw out fluid and cells for analysis.

Core Needle Biopsy

A larger needle with a cutting tip is used to draw a column of tissue out of a suspicious area.

Stereotactic Biopsy

This is performed in order to get tissue from a lump that cannot be felt during the breast exam. The surgeon will use a special type of X-ray imaging to find the lump that the needle must target in order to get an accurate tissue sample. The needle will follow the X-ray to the area and take a tissue sample. Some surgeons will place a small metal chip at the biopsy site after taking the tissue sample so that future mammograms or ultrasounds will indicate where the biopsy was done.

You may experience mild discomfort after these procedures, but will be able to resume normal activity within a day or so.

Open Biopsy

Definition/Overview

An open biopsy is a procedure in which a surgical incision is made through the skin to expose and remove tissues. The tissue is then examined by a pathologist. In some cases, the lump may be removed along with surrounding tissue.

Procedure

During this procedure, you will either be given local anesthesia, local anesthesia with sedation, or general anesthesia. This will depend on the patient as well as the size and location of the lump.

The surgeon will make an incision and remove the breast tissue sample and lump if necessary. After the sample is taken, the incision is sutured and a dressing is applied.

Pain medication may be prescribed, and there may be soreness in the area, but generally patients can resume normal activity within a day or two.

Sentinel Lymph Node Biopsy

Definition/Overview

The sentinel lymph node is the first lymph node to which cancer cells are likely to spread from the primary tumor. Cells may appear in the sentinel node before spreading to other lymph nodes. Sentinel node biopsies are used to help determine the stage of cancer.

Procedure

During a sentinel lymph node biopsy, the surgeon removes one to five sentinel lymph nodes and sends them to a pathologist to determine if cancer cells have spread to them. If cancer is found in these lymph nodes, it is an indication that the disease has metastasized (spread).

Before the procedure, the physician will numb the area and inject a blue dye or special tracer substance into the area around the original cancer site. The dye or tracer then moves to the first lymph node (sentinel node) that drains closest to the cancer site. The dye or tracer makes a map pattern of lymphatic fluid that shows where the cancer is likely to spread. That lymph node is removed, cut into thin slices, and viewed under a microscope. If the sentinel node is positive for cancer cells, additional surgery will be done to remove more lymph nodes.

This is an outpatient procedure, and you may either be given general anesthesia, or a sedative to help you relax. The procedure itself takes 30 to 60 minutes. The biopsy site may be sore for several days after surgery, but you should be able to resume most activities within a day or two.

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