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SURGICAL PROCEDURES

Most breast cancer patients will have some type of surgery, whether it's a breast conservation therapy such as lumpectomy or the removal of the entire breast (mastectomy). The type of surgery you have depends on many factors, and our physicians will help you make the decision that's right for both your individual case and your personal preferences. All of our breast surgeons are leaders in the field of breast cancer care.

Breast-Conserving Surgery

If your cancer is diagnosed at an early stage, our surgeons may perform a lumpectomy. During this procedure, the surgeon will remove the entire lump and some of the normal tissue (the margin) surrounding it, but will preserve the breast. Intraoperative touch prep cytology is used to check the margins during surgery. This can allow the surgeon to remove additional breast tissue if necessary to avoid the need for a reexcision to be performed.

Radiation therapy is given after the lumpectomy and is an essential part of this breast-conserving treatment. For most women with stage I or II breast cancer, the combination of lumpectomy and radiation treatment has proven to be as effective as modified radical mastectomy.

These procedures remove more breast tissue than a lumpectomy, and radiation therapy is also part of the treatment.

For patients who have had a prior lumpectomy and radiation and who develop a recurrence in the same breast, we offer wide resection with brachytherapy, which allows the patient a second chance for breast conservation. The standard of care for such patients has been a mastectomy, but this approach allows selected patients to have a second lumpectomy done with a type of radiation implant called brachytherapy.

For breast lumps that are benign (noncancerous), our surgeons can treat them using a procedure called Fibroadenoma Cryoablation. This procedure uses cold therapy to destroy the tissue, rather than the traditional surgical removal. The surgeon uses ultrasound to guide a small instrument into the breast, and the tip of this instrument will become extremely cold and freeze the benign lump. This outpatient treatment takes only about 30 minutes.

Mastectomy

If a mastectomy is the best treatment choice for your case, there are several types of mastectomy procedures that our surgeons may perform. A total mastectomy, also called a simple mastectomy, removes the entire breast without the axillary lymph node dissection. A modified radical mastectomy removes the entire breast and most axillary lymph nodes, but the pectoralis (chest) muscle stays in place.

Our surgeons are also experts in skin-sparing mastectomies (SSM), during which the breast tissue is removed while all of the healthy skin is preserved. This allows the shape of the reconstructed breast to be preserved as normal with minimal visible scars. A nipple areola-sparing mastectomy is similar to a skin-sparing one, with the addition that the nipple areola complex is preserved.

Axillary Lymph Node Dissection and Sentinel Node Biopsy

Both lumpectomy and mastectomy procedures may be accompanied by either a sentinel node biopsy or a full axillary node dissection. Both of these procedures help physicians determine if the cancer has spread to the axillary (underarm) lymph nodes, which in turn helps them select which adjuvant therapy, such as chemotherapy or radiation therapy, is best for your case.

Our surgeons have extensive experience and expertise with sentinel lymph node biopsy, which is an important surgical advance. Rather than removing most underarm lymph nodes, as is done in the axillary lymph node dissection, surgeons inject a low-level radioactive tracer into the breast area around the tumor. The tracer leads surgeons to the sentinel node—the first lymph node to receive drainage from a cancer-containing area of the breast—which is then removed and tested to see if the cancer has spread to the lymph node system.

The advantage of this procedure is that surgeons only have to take out the most important node(s). This minimizes the risk of arm swelling and allows the pathologists to do a more complete evaluation to determine if the node(s) contain cancer. If the sentinal node doesn't contain any cancer cells, no further surgery is necessary. However, if the sentinel node does contain cancer, an axillary dissection may be recommended—either at the same time or several days later. Most patients will have their sentinel node biopsy performed at the time of lumpectomy or mastectomy. A newer technique allows this to be done without the need to make a separate axillary (armpit) incision.

Breast Reconstruction

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If you have a mastectomy, then you may wish to consider reconstructive surgery. Reconstruction can be performed immediately, it can be delayed, or you may not wish to undergo reconstruction at all. Reconstruction may use implants or tissue from other parts of your body. There are many choices to make, and such decisions are based on your medical situation and personal preferences. The Comprehensive Breast Service works closely with plastic surgeons who are experts in breast reconstruction and who will be involved with you during the decision-making process. For more information on our breast reconstruction services, click here.

Second Opinion of a Breast Cancer Diagnosis

Our breast cancer team has the expertise to provide the most accurate and immediate diagnosis and staging of breast disease, and many patients turn to us for second opinions of a breast cancer diagnosis or if they have an abnormal mammogram, sonogram (ultrasound), or MRI. While these breast imaging studies can be helpful in making an early diagnosis of significant breast disease, differences in techniques and interpretations can make final conclusions difficult. Our four dedicated breast radiologists are experts in making the most accurate diagnosis possible.

For a second opinion of a breast cancer diagnosis, we evaluate in detail the breast imaging studies, pathology slides, and physical examination. Often special views or other diagnostic studies may be recommended, and if needed, we utilize minimally invasive biopsy techniques to make a definitive diagnosis. In addition, our patients benefit by having their case reviewed at the weekly multidisciplinary breast conference described above.

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