Surgery is the standard treatment for nearly all breast cancers. Surgery is usually either a lumpectomy, which removes the tumor from the breast, or a mastectomy which involves the removal of the entire breast itself. The type of surgery that is used depends on many factors, and is something that is best discussed with a breast surgeon. Sometimes surgery will also involve removing some or many lymph nodes from the axilla or armpit area so they can be examined under a microscope to establish whether there is a risk of spread to that area. The surgical procedures are discussed here:
Lumpectomy is sometimes known as a partial mastectomy. It involves the removal of the mass and usually a rim of normal tissue around it to ensure that any adjacent 'rootlets' of tumor are also removed. Lumpectomy is typically followed by radiation therapy which can then 'mop-up" any cells that may be left behind. Lumpectomy and radiation is often termed Breast Conservation Therapy, or BCT.
As noted above, Breast Conservation Therapy involves a lumpectomy + radiation therapy. The goal of BCT, in comparison to a mastectomy, is to preserve the breast with an equal cure and survival rate to mastectomy. Numerous studies over the past 30 years have compared the outcome and survival of women having either a lumpectomy and radiation or a mastectomy as their breast cancer treatment. All of these studies, which have been performed at major institutions around the world, have confirmed the survival and cure rate equivilence of lumpectomy + radiation to mastectomy. In BCT, surgery and radiation works hand-in-hand. Since the surgeon knows that radiation will be used to aid in sterilizing the tissue after surgery, he/she is able to offer a less disfiguring surgery, which allows a woman to retain her breast without sacrificing curability. The most important thing to remember about lumpectomy and radiation is that it allows an equivilent survival to mastectomy. In other words, there is no medical benefit in most cases (see below) to preserving the breast and undergoing lumpectomy and radiation instead of mastectomy.
Mastectomy is performed in certain situations, including in women who prefer this option over lumpectomy + radiation. It is also preferred over a lumpectomy in women who may not live in an area where radiation is readily available or in women with the collagen vascular disease known as scleroderma. One of the more common reasons that a mastectomy may be recommended is when women are found to have more than one lesion in the breast, especially if these lesions are in separate quadrants or regions, making a lumpectomy a more disfiguring procedure; that is the opposite goal of a lumpectomy. Today, a modified radical mastectomy is usually performed, removing the breast tissue but leaving the underlying muscle behind. Following a mastectomy, either during the same procedure, or weeks to months later, a reconstruction procedure can be performed to create a breast that has good cosmesis and symmetry, in other words, a breast that looks very much like the one that was removed.
During a lumpectomy or mastectomy procedure, the axillary lymph nodes are removed so that they can be reviewed microscopically. These lymph nodes are located at and near the armpit, and can be one of the first places that a cancer cell travels, making them a good predictor of whether or not any cells may have escaped out of the breast. Today, a procedure known as a sentinel node biopsy has replaced, in most cases, the more invasive full axillary lymph node dissection as a means of getting this lymph node information. Full axillary dissections can increase the risk of causing significant distruption of the lymphatics, which can lead to long-term swelling of the arm (a condition known as lymphedema).
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