Exon Publications, Brisbane, Australia
Breast cancer is a significant health concern, affecting millions of women worldwide. Surgery plays a pivotal role in its management, offering curative and palliative options to patients. This chapter explores the surgical treatment for breast cancer in accessible terms, detailing various surgical techniques, their indications, preparation processes, recovery phases, and potential complications. Additionally, it discusses life after surgery and emphasizes the importance of holistic care in ensuring the best possible outcomes for patients and their loved ones. By understanding the available surgical options and their implications, patients can make informed decisions in collaboration with their healthcare providers.
Keywords: Axillary Lymph Node Dissection; Breast Reconstruction Surgery; Complications and Side Effects of Breast Cancer Surgery; How effective is Surgical Treatment for Breast Cancer; Life after Mastectomy; Lumpectomy; Modified Radical Mastectomy; Partial Mastectomy; Preparation for Breast Cancer Surgery; Radical Mastectomy; Recovery and Postoperative Care; Sentinel Lymph Node Biopsy; Total Mastectomy; When is Surgery used for Breast Cancer
Correspondence: Exon Publications, Brisbane, Australia. books@exonpublications.com
Cite as: Surgical Treatment of Breast Cancer. Brisbane (AU): Exon Publications; 2024. Published on 07 Dec.
Doi: https://doi.org/10.36255/surgical-treatment-breast-cancer
Copyright: Exon Publications.
License: This article is published under Attribution-NonCommercial-NoDerivatives license (BY-NC-ND 4.0) https://creativecommons.org/licenses/by-nc-nd/4.0/
Breast cancer is a condition where abnormal cells in the breast tissue grow uncontrollably, often forming a lump or mass. If untreated, these cells can spread to other parts of the body. Surgery is often the cornerstone of treatment, either alone or in combination with therapies like chemotherapy, radiation, or targeted treatments. Surgical options range from breast-conserving techniques, such as lumpectomy, to complete removal of the breast, known as mastectomy. The type of surgery chosen depends on the stage of cancer, the patient's overall health, and their personal preferences. Advances in surgical techniques and supportive care have improved survival rates and quality of life for many patients (1–5).
Surgical treatment is typically indicated for individuals diagnosed with breast cancer to remove the tumor and reduce the risk of recurrence. It is also recommended for cases where a genetic predisposition, such as mutations in BRCA1 or BRCA2 genes, increases the likelihood of cancer development. Surgery may also be performed to manage complications, such as severe pain or infection, caused by advanced cancer. In early-stage cancers, surgery can often provide a cure when combined with additional treatments like hormone therapy (e.g., tamoxifen) or targeted drugs like trastuzumab (Herceptin). For more advanced cancers, surgery may be used to alleviate symptoms and improve quality of life.
Preparing for surgery begins with a thorough consultation with your healthcare team. Patients undergo diagnostic tests such as mammograms, ultrasounds, and sometimes MRI scans to evaluate the extent of cancer. A biopsy confirms the diagnosis, and additional blood tests may be performed to assess overall health. The patient meets with a surgeon to discuss the type of surgery, expected outcomes, and any potential risks. In cases of genetic predisposition, genetic counseling may be offered to help patients understand their risks and options. Preoperative instructions often include fasting, medication adjustments, and arrangements for postoperative support at home. Emotional preparation is also essential, as surgery can be a significant emotional and physical experience.
A lumpectomy, also known as breast-conserving surgery, involves removing the tumor and a small margin of surrounding healthy tissue. This procedure is typically recommended for early-stage breast cancer when the tumor is small and localized. The goal is to preserve as much of the breast as possible while ensuring complete removal of cancerous cells. Lumpectomy is often followed by radiation therapy to reduce the risk of recurrence. Recovery from lumpectomy is usually faster than from more extensive surgeries, with many patients resuming normal activities within a few weeks. However, regular follow-up care is essential to monitor for any signs of recurrence.
Partial mastectomy involves the removal of a larger portion of breast tissue compared to a lumpectomy. This procedure is chosen when the tumor is more extensive but still localized. Like lumpectomy, it aims to conserve as much of the breast as possible while ensuring cancer-free margins. Partial mastectomy is often accompanied by radiation therapy and sometimes chemotherapy or hormone therapy, depending on the cancer's characteristics. Recovery times vary based on the extent of tissue removal, and some patients may experience changes in breast shape or symmetry, which can be addressed with reconstructive options if desired.
Total mastectomy entails the complete removal of the breast, including the nipple and areola, but without removing lymph nodes or chest wall muscles. This procedure is commonly recommended for individuals with larger or multiple tumors, or for those with a genetic predisposition to breast cancer. It may also be a preventive measure for high-risk individuals. Advances in surgical techniques, such as skin-sparing and nipple-sparing mastectomy, have improved aesthetic outcomes and patient satisfaction. Recovery typically involves a hospital stay of one to two days, followed by several weeks of healing at home. Emotional support and counseling can be valuable for coping with the physical and emotional changes after surgery.
Modified radical mastectomy involves the removal of the entire breast along with axillary lymph nodes. This surgery is indicated for invasive breast cancers that have spread to nearby lymph nodes. By removing the affected nodes, the procedure helps prevent further spread of the disease. This surgery is more extensive than a total mastectomy, resulting in longer recovery times and a greater likelihood of complications such as lymphedema, which is swelling caused by lymph fluid buildup. Despite these challenges, this surgery remains an important option for managing advanced cancers and improving survival rates.
Radical mastectomy, which includes removal of the breast, chest wall muscles, and lymph nodes, is a less commonly performed surgery today. It is usually reserved for cases where cancer has extensively invaded the chest wall. Although effective in controlling advanced disease, it has largely been replaced by less invasive surgeries that achieve similar outcomes with fewer side effects. Recovery from radical mastectomy can be challenging, requiring extensive physical and emotional support. Advances in other treatments have significantly reduced the need for this procedure, but it remains an important part of breast cancer surgical history.
Sentinel lymph node biopsy is a minimally invasive procedure used to determine if breast cancer has spread to the lymphatic system. During this procedure, the first few lymph nodes (sentinel nodes) that drain the area around the tumor are identified using a special dye or radioactive tracer. These nodes are then removed and examined for cancer cells. If no cancer is found, further lymph node removal may be unnecessary, reducing the risk of complications such as lymphedema. This procedure has become a standard part of breast cancer surgery, offering valuable information with minimal impact on the patient.
Axillary lymph node dissection involves the removal of multiple lymph nodes from the underarm area. It is typically performed when cancer is detected in the sentinel nodes, indicating a higher likelihood of further spread. While effective in controlling the disease, this procedure carries a higher risk of complications like lymphedema and reduced arm mobility. Physical therapy is often recommended to help patients regain strength and movement after surgery. Advances in imaging and sentinel lymph node biopsy techniques have reduced the need for full lymph node dissection in many cases, but it remains a critical option for managing certain cancers.
Breast reconstruction surgery is an option for individuals who have undergone mastectomy or lumpectomy. Reconstruction can be performed using implants or tissue from other parts of the body, such as the abdomen or back. The timing of reconstruction varies; it can be done immediately following cancer surgery or delayed until after other treatments are completed. Advances in techniques, including autologous tissue reconstruction and 3D nipple tattooing, have improved outcomes and patient satisfaction. Reconstruction helps restore the breast's appearance and can have a positive impact on self-esteem and quality of life. However, it is a personal decision, and some patients choose not to pursue reconstruction.
Recovery after breast cancer surgery involves both physical and emotional healing. Patients are encouraged to rest and follow their surgeon’s instructions, including wound care, managing drains, and recognizing signs of infection. Pain management is an important part of recovery, and medications are often prescribed to ensure comfort. Gentle exercises may be recommended to prevent stiffness and improve arm mobility. Emotional support, whether through counseling, support groups, or loved ones, is crucial during this time. Regular follow-up appointments are necessary to monitor healing and assess the need for additional treatments such as radiation or chemotherapy.
Surgical treatment is one of the most effective and commonly used methods for managing breast cancer. It plays a central role in removing cancerous tissue from the breast and is often the first step in treatment for many patients. For early-stage breast cancer, surgeries such as lumpectomy (breast-conserving surgery) or mastectomy (complete removal of the breast) can achieve excellent outcomes when combined with other therapies like radiation or chemotherapy. Advances in surgical techniques have made procedures more precise and less invasive, improving cosmetic results and reducing recovery times. Sentinel lymph node biopsy and axillary lymph node dissection help determine whether the cancer has spread, guiding further treatment decisions. Surgical treatment is particularly effective in localized cancers, offering a high likelihood of long-term remission and cure when detected early. When paired with neoadjuvant or adjuvant therapies, surgery ensures comprehensive treatment by addressing both visible and microscopic cancer cells. For many patients, surgical intervention provides a significant reduction in the risk of recurrence and forms the foundation of a personalized and successful breast cancer treatment plan.
Complications from breast cancer surgery can include infection, bleeding, and delayed wound healing. Specific side effects depend on the type of surgery and may include lymphedema, numbness, or changes in breast shape. Lymphedema, a common complication of lymph node removal, can cause swelling in the arm and discomfort. Physical therapy and compression garments are often used to manage this condition. Emotional challenges, such as anxiety or depression, are also common and should not be overlooked. Early recognition and management of complications are essential to ensure the best possible recovery and quality of life.
Life after mastectomy can be challenging. Many individuals find comfort in knowing that surgery has removed their cancer and significantly reduced their risk of recurrence. Adjusting to physical changes may take time, and some choose to use prosthetics or undergo reconstruction. Emotional support, whether through therapy, support groups, or online communities, can be invaluable. Regular follow-ups and a healthy lifestyle, including a balanced diet and exercise, are important for maintaining overall health and well-being. Advances in survivorship care have made it possible for many individuals to lead active, fulfilling lives after breast cancer surgery.
Surgical treatment for breast cancer is a critical component of care, offering hope and healing to millions of patients. From breast-conserving procedures like lumpectomy to more extensive surgeries such as mastectomy, each option has its place in a comprehensive treatment plan. Advances in surgical techniques, combined with effective therapies and supportive care, have improved outcomes and quality of life for many individuals. By understanding the options and their implications, patients and their loved ones can navigate the journey with confidence, making informed decisions in collaboration with their healthcare team.
This article is part of the Public Education Series initiative by Exon Publications. It was written by professional medical writers for the general public in plain language, based on peer-reviewed articles indexed in PubMed, and further reviewed for scientific accuracy by experts. The views and opinions expressed in this article are believed to be accurate at the time of publication. However, the publisher, editors, and authors cannot be held responsible or liable for any errors, omissions, or consequences arising from the use of the information provided. The publisher makes no warranties, explicit or implicit, regarding the contents of this article or its use. The information in this article is intended solely for informational purposes and should not be considered medical advice.