Which kind of surgery is done for breast cancer?
Surgery for breast cancer can be divided into two parts- surgery for the
breast and surgery for the axilla (axillary lymph glands)
Surgery for the breast:
1. Breast preserving operation- Tumor size, breast size, presence of more
than one tumour in the breast and stage of the disease all help to determine
if the breast can be preserved during surgery. If you are a candidate for
breast preserving option and offered this option, you should know that the
survival ( longevity of life) is not affected by preserving the breast and
that it is a safe surgery. One must note that if you choose to have a breast
preserving surgery, it must be followed up with radiation.
2. Mastectomy ( removal of the whole breast)- When it is not possible to save
the breast, or the patient chooses to have her breast removed, then a
mastectomy is done. The skin is put together after the surgery and there is
no raw area. At the end of the surgery, there is a flat straight surgical
scar.
3. Oncoplasty- Sometimes when a large area of tissue has to be removed during
a breast conservation surgery, the gap to fill is large and just closing it
as it is may give an ugly result. Therefore, tissue and fat from the
neighbouring areas like the back or side fat or breast tissue itself is
remoulded to fill in the gap and give a better outside.
4. Reconstruction- There are options to create a new breast with ones own
tissue ( commonly the tummy fat) or with an implant ( made of silicon) to
make a new breast after a mastectomy. This can either be done at the time of
the first surgery itself or as a second surgery anytime in the future.
Surgery for the axilla- Surgery for the axilla is always part of the
treatment for any breast cancer. If done with the mastectomy, there is no
separate scar; but if done with breast conservation there may be a separate
scar in the area of the armpit.
1. Sentinel lymph node biopsy- This is a procedure where the first set of
lymph nodes draining the breast in the axilla are marked out by special
techniques and they are removed and sent for testing. If cancer has spread
to these lymph nodes, then an axillary clearance is usually done and if the
nodes do not have cancer, then there is no further surgery done in the
axilla. This all usually happens when one is under anaesthesia itself (
frozen section for the lymph nodes) and does not need to be done as a
separate procedure.
2. Axillary clearance- This is a surgery to remove all the lymph nodes in the
armpit and is also done in the same anaesthesia as the breast surgery. If we
know before surgery that the lymph node is involved or if there was a
positive node on sentinel lymph node biopsy then this procedure is
performed.
At the end of a mastectomy and/or an axillary clearance, a drain is placed
and these come out below the wound and are left in place for 7-10 days. They
are meant to drain the fluid from the wound and this may be a little
blood-tinged. Once the amount coming out reduces, the drain is removed.
Are there any alternatives besides surgery?
Till date, surgery is the only proven curative option for breast cancer.
How do I prepare myself for surgery?
The preparation is generally similar to any major surgery. Breathing
exercises using the incentive spirometer should be started. Wherever needed,
a sports bra, pocketed bra and appropriate clothing can be planned and taken
to the hospital. Follow the anaesthetist’s advice regarding the continuation
of medications if you are on any.
How major is surgery? What are the possible complications?
Surgery for breast cancer, both mastectomy and breast conservation surgery
(even with oncoplastic procedures), although referred to as major surgeries
do not usually have any serious complications.
The complications of these surgeries include:
- Wound Infection
- Flap necrosis
- Bleeding
- Numbness in the medial
aspect of the arm and scar site
- Lymphedema
- Prolonged seroma
For how long do I stay in the hospital?
Most of the surgeries for breast cancer are done as a daycare procedure; that
is you can get the surgery done in the morning and go home the same day.
Sometimes you are asked to stay for one night just so that you can be
monitored and then are sent home the next day morning.
Will I need any further treatment after surgery?
The decision about adjuvant treatment is based on the final histopathology
report which will be available approximately 7-10 days following surgery.
Depending on the report, the decision to give chemotherapy (with or without
targeted therapy) is taken. Radiation is generally given if you have had a
breast conservation surgery or if you have had a mastectomy, and the
pathology report shows that the size is large or that your lymph nodes are
positive. Hormone therapy (which is in the form of tablets) is given for 5
or ten years if you have a hormone-positive tumour.
What will be my survival after surgery? Are there any chances of
cancer coming back?
Survival depends on the stage of the disease. The average 5-year survival for
all stages after curative surgery and treatment for breast cancer is between
80-95% depending on the stage of cancer. As of date, there is no foolproof
way of predicting which patients will have a recurrence and which patient
will not.
Are there any special precautions I need to take to prevent cancer
from coming back?
A good healthy lifestyle, prevention from weight gain and taking your
medications regularly can all add to helping cancer from coming back.
How frequently should I follow up after surgery?
After completion of treatment, you will be advised to follow-up once in 3
months in the first year. Then the frequency will be reduced to once in 6
months for the next 4 years. Subsequent follow up will be once a year. Each
year, you will be asked to do certain blood tests and an ultrasound of the
abdomen. You will also be asked to do a mammogram yearly; if you have had a
mastectomy, you will be asked to do a mammogram of the opposite breast and
if you have had a conservation surgery then you will be asked to do a
bilateral mammogram. It is similar to a routine master health check-up that
people without cancer have yearly and any abnormality can then be
investigated further.
Will I be able to adjust to this disease well?
It is only the duration of the treatment that everything may seem to be
difficult and there may be small challenges along the way. The first few
days of diagnosis are the hardest because you have to both accept what has
been told to you and you have to make decisions quickly while your mind is
still trying to process the information. Once you start the treatment
process, things become easier and after the treatment, you can live a
completely normal life and will be able to do almost everything that you
were able to do before cancer. Many patients do well and have a full
recovery.