Generally Speaking

When breast surgery is recommended for cancer, how will the surgeon determine the best surgery option?

Decisions about surgery depend on many factors. These include the stage of the cancer, location, size, and most importantly, the desires of the patient. Most women with breast cancer have some type of surgery.

Under many circumstances, people with breast cancer have the opportunity to choose between total removal of a breast (mastectomy) and breast-conserving surgery (lumpectomy) followed by radiation. A discussion with your surgeon will determine the best surgery options for you.

All patients with a diagnosis of breast cancer need to have some form of surgical assessment or staging of their axillary lymph nodes. This is done with a procedure called: Sentinel Lymph Node Mapping and biopsy, which allows a few key lymph nodes to be removed for extensive testing by the pathologist. If one or more of the sentinel lymph nodes contains cancer, the remainder of the lymph nodes should be removed with a completion axillary node dissection. This can be done at the time of the original surgery (if the metastasis is picked up on frozen section), or it can be done at a later date.

What happens after breast surgery? What kind of recovery should I expect?
If you are undergoing breast conserving therapy (lumpectomy) with sentinal lymph node dissection only, it's likely that your surgery will be done on an outpatient basis. This means that you can go home on the same day you have your surgery. Total mastectomy and axillary lymph node dissection are more invasive surgeries and require a hospital stay. Most patients are discharged the day after surgery with either one or two drains in place.

Most patients will be up and moving around several hours after surgery, and begin arm exercise the following day to prevent stiffness. Normal activities should resume a few days after lumpectomy and within a few weeks after mastectomy.

When should I ask about breast reconstruction options?
Breast reconstruction surgery is a decision that is based on many personal factors. The choices that may be right for one woman may not be right for another. Your surgeon can help you decide the best time for reconstruction.

Timing of reconstructive surgery is based on the woman's desires, other medical conditions, and cancer treatment. For many women, immediate reconstruction reduces the emotional trauma of having a breast removed, and avoids the expense and discomfort of undergoing two major operations. Cosmetic results also may be better with immediate reconstruction.

Delayed reconstruction can also be an option. This may be advised if radiation to the chest area is needed after the mastectomy, because radiation therapy that follows breast reconstruction can increase the chance of complications with the reconstructed breast. Also breast reconstruction can be a lengthy surgery with its own set of complications and it can be a lot added to an already stressful and emotional situation, and some wish to delay for this reason.

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