October is National Breast Cancer Awareness Month and we at Preferred Care at Home seek to honor the fight against breast cancer and provide support for those currently facing the battle with cancer. While breast cancer can affect patients of all ages, even in one’s 20’s, the risk of breast cancer continues to increase with age and approximately ⅓ of breast cancer diagnoses occur in patients over 70 years old.1
As many breast cancer survivors will tell you, navigating the healthcare maze of breast cancer treatment can be confusing and overwhelming at times. Surgery, chemotherapy, and radiation therapy seem invasive when compared to taking a pill for a common medical condition. To make matters more confusing, new research can lead to changing society guidelines or recommendations. In this article, I hope to provide some clarity by answering a few common questions related to breast cancer surgery.
I have heard about different types of mastectomies. What options are available to me?
The surgical management of breast cancer has changed significantly since William Stewart Halsted introduced what is now known as the ‘radical mastectomy’ at Roosevelt Hospital in New York City in 1882. That procedure involved removal of all breast tissue,the pectoralis muscles of the chest wall, overlying skin, and all regional lymph nodes. While this technique provided remarkable advances in achieving a cure from breast cancer, you can imagine that such an invasive procedure left many patient struggling with the effects of nerve damage, significant lymphedema, and disfigurement.
In healthcare today, great effort is made to achieve the highest possible cure rates with the least invasive surgery. Combination treatment with chemotherapy or radiation therapy provides some patients the option to undergo less aggressive surgery than would otherwise be needed. The surgical options available to each patient depend on several factors, including the particular stage one’s breast cancer. If you are currently facing evaluation for treatment of breast cancer, here are descriptions of several types of mastectomies.
Modified Radical Mastectomy
This surgery involves removal of the all breast tissue including the tumor, the nipple, areola, and skin overlying the tumor, as well as the axillary (under arm) lymph nodes.
Simple Mastectomy (synonymous with ‘Total Mastectomy’)
This surgery is less invasive than the modified radical mastectomy as only the breast tissue and skin components removed. The axillary lymph nodes are not removed in this procedure. In some cases, ‘skin-sparing’ or ‘nipple-sparing’ mastectomy may be an option.
Breast Conservation Therapy (synonymous with ‘Lumpectomy’)
This surgery involves removing the breast cancer but leaving behind some amount of normal breast tissue. When combined with radiation therapy, this treatment option can provide high treatment success with a better cosmetic outcome.
My physician mentioned the need for a sentinel lymph node biopsy. What is involved in this procedure and why is it necessary?
One of the important factors in determining the stage of breast cancer is whether or not the axillary (under arm) lymphnodes contain cancer. The positive or negative result will have a significant impact on one’s treatment. One way to determine if there is cancer is to remove a majority of the axillary lymph nodes, what is called an ‘axillary lymph node dissection.’ While it seems logical to want to remove as many lymph nodes as possible, there can be significant complications of aggressive lymph node removal such as serious nerve damage and lymphedema of the arm.
The sentinel lymph node biopsy provides reliable information about whether there is cancer in the lymph nodes while removing far less lymph nodes. The procedure, which may be performed at the same time of breast conservation therapy, involves the injection of a dye or radioactive tracer into the affected breast. This then travels to the involved lymph nodes, and the surgeon is able to visualize or use a special detector to identify the ‘sentinel’ lymph node, which is then removed. This procedure is less invasive and better tolerated by the patient when compared to axillary lymph node dissection.
What are the options for breast reconstructive surgery? Do I have to decide by the time of the initial surgery or can I decide to have breast reconstruction later?
The goal of breast reconstructive surgery is to correct any visual abnormality following mastectomy and improve cosmetic appearance. The decision to undergo breast reconstruction is a deeply personal choice, and should be discussed at length with your surgeon prior to undergoing the knife. Some patients may have the option to undergo immediate reconstruction at the time of mastectomy depending on the particular cancer type and treatment plan. However, if you are not sure if you want reconstruction right away, you may always choose to proceed at a later time. After discussion with your surgeon, some patients may end up with a better cosmetic result if reconstruction is delayed until other cancer treatment can be completed.
As I mentioned earlier, the treatment of breast cancer is a topic that can be confusing and complex. The most important factor is to find a physician who you connect with and who explains the treatment process clearly. This October, take the time to talk with others or share information on social media about breast cancer awareness. Together, we can support those we know who press on in the fight against breast cancer.
1Tesarova P. Breast cancer in the elderly—Should it be treated differently? Reports of Practical Oncology and Radiotherapy. 2013;18(1):26-33. doi:10.1016/j.rpor.2012.05.005.
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