Breast cancer surgery

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]

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Overview

Surgery is the mainstay of treatment for breast cancer.

Surgery

Surgery involves the physical removal of the tumor, typically along with some of the surrounding tissue and frequently sentinel node biopsy.

Standard surgeries include:

• Mastectomy: Removal of the whole breast.
• Quadrantectomy: Removal of one-quarter of the breast.
• Lumpectomy: Removal of a small part of the breast.

If the patient desires, then breast reconstruction surgery, a type of cosmetic surgery, may be performed to create an aesthetic appearance. In other cases, women use breast prostheses to simulate a breast under clothing or choose a flat chest.

• Breast-conserving surgery, a less radical cancer surgery than mastectomy

Mastectomy

Mastectomy (from Greek μαστός "breast" and ἐκτομή ektomia "cutting out") is the medical term for the surgical removal of one or both breasts, partially or completely.

A mastectomy is usually carried out to treat breast cancer. In some cases, people believed to be at high risk of breast cancer have the operation prophylactically, that is, as a preventive measure. It is also the medical procedure carried out to remove cancerous tissues. Alternatively, some patients can choose to have a wide local excision, also known as a lumpectomy, an operation in which a small volume of breast tissue containing the tumor and a surrounding margin of healthy tissue is removed to conserve the breast.

Both mastectomy and lumpectomy are referred to as "local therapies" for breast cancer, targeting the area of the tumor, as opposed to systemic therapies, such as chemotherapy, hormonal therapy, or immunotherapy.

Traditionally, in the case of breast cancer, the whole breast was removed. Currently, the decision to do the mastectomy is based on various factors, including breast size, the number of lesions, biologic aggressiveness of a breast cancer, the availability of adjuvant radiation, and the willingness of the patient to accept higher rates of tumor recurrences after lumpectomy and radiation. Outcome studies comparing mastectomy to lumpectomy with radiation have suggested that routine radical mastectomy surgeries will not always prevent later distant secondary tumors arising from micro-metastases prior to discovery, diagnosis, and operation

Complications

• After surgical intervention to the breast, complications may arise related to wound healing. As in other types of surgery, hematoma (post-operative bleeding), seroma(fluid accumulation), or incision-site breakdown (wound infection) may occur.

• Breast hematoma due to an operation will normally resolve with time but should be followed up with more detailed evaluation if it does not. Breast abscess can occur as a post-surgical complication, for example after cancer treatment or reduction mammaplasty. Furthermore, if a breast has already undergone irradiation (as in radiation therapy for treating breast cancer), there is a heightened risk of complications (e.g. reactive inflammation, the occurrence of a chronic draining wound, etc.) for breast biopsies or other interventions to the breast, even those often considered "minor" surgeries. The combined effects of radiation and breast cancer surgery can in particular lead to complications such as breast fibrosis, secondary lymphedema (which may occur in the arm, the breast or the chest, in particular after axillary lymph node dissection), breast asymmetry, and chronic/recurrent breast cellulitis, each of these having long-term effects.

• Ultrasound can be used to distinguish between seroma, hematoma, and edema in the breast. Further possible complications are fat necrosis (premature cell death of fat cells) and scar retraction (shrinking of the area around the surgical scar). In rare cases after breast reconstruction or augmentation, late seroma may occur, defined as seroma occurring more than 12 months postoperatively.

• There is preliminary evidence suggesting that negative-pressure wound therapy may be useful in healing complicated breast wounds resulting from surgery.

• Postoperative pain is common following breast surgery. The incidence of poorly controlled acute postoperative pain following breast cancer surgery ranges between 14.0% to 54.1%. Regional anesthesia is superior compared to general anesthesia for the prevention of persistent postoperative pain three to 12 months after breast cancer surgery.

• In post-surgical medical imaging, many findings can easily be mistaken for cancer. In MRI, scars that occurred many years before are normally "silent".