Breast Surgery

Surgical Treatments

Removal of Benign Masses and Breast Carcinomas

• Benign Masses - Most types of benign breast masses do not require treatment. A physician may recommend treatment or removal if you have a type that increases your future risk of breast cancer. Often a lumpectomy will be performed to remove the abnormal breast tissue. During a lumpectomy procedure, the surgeon removes the abnormal tissue and a small amount of the healthy tissue that surrounds it. This ensures that all of the abnormal tissue is removed. A lumpectomy is frequently done as an outpatient surgery. Patients may be given general or local anesthesia for the procedure which takes approximately one hour.
• Breast Carcinomas - Surgery can be an effective treatment for breast cancer. In some situations, a lumpectomy is performed to remove an isolated tumor. In other situations, a mastectomy, which is removal of the entire breast, may be required.
• Lumpectomy – Breast Conservation - A lumpectomy is a type of surgery that helps to preserve the breast. It is often used in early-stage breast cancers when the tumor is small in relation to the size of the breast. For people who have a lumpectomy, the breast surgeon will recommend follow-up radiation therapy.

There are different types of lumpectomies which include:

• • Excisional – this is a procedure that removes a tumor for a biopsy to determine if it is benign or malignant
  • Wide-local excision – removes the malignant tumor and some surrounding tissue to test for cancer
  • Re-excision – when the surrounding tissues tests positive for cancer, the surgical site will be reopened to remove additional tissue until tissue comes back cancer-free
• Lumpectomies

• • Wire localization method– This procedure is less frequently used. A radiologist places a wire down to biopsy proven cancer. The surgeon then uses the wire as a guide to excise the cancer. This procedure is performed the day of surgery.
  • High-frequency tag locator method – A digital tag is placed in the breast where the biopsy clip indicates cancer is present. This then guides the surgeon where to place the incision and guides removal. This procedure can be performed several days prior to surgery for convenience.
  • Radioactive seed localization – This method is not used here due to the radioactive nature and precautions necessary.
• Mastectomy (including Partial and Simple)

There are different types of mastectomies which include:

• • Simple mastectomy -- removes the entire breast but spares the chest muscle.
  • Double mastectomy – removes both breasts
  • Modified radical mastectomy – in addition to removal of the breast tissue, underarm lymph nodes are removed to reduce the risk of the cancer spreading
  • Nipple- or skin- sparing mastectomy – while the breast tissue is removed, the skin and nipple remain for breast reconstruction – most often used in prophylactic surgery in genetic mutation patients
• Lymph Node Surgery
  • Sentinel Node Excision – the most common procedure performed. Once the patient is asleep, the breast is injected with a radionuclide and blue dye. Lymph nodes that are high in count and blue dye are removed – sentinel nodes. If the nodes do not show cancer cells, then no further lymph node removal is needed. This procedure decreases the onset of lymphedema.
  • Complete Dissection – may need to be performed in more advanced cancers or if sentinel nodes show cancer cells. This is preferred if the sentinel nodes cannot be identified.
  • Prophylactic Sentinel Node Excision – Often performed in conjunction with mastectomies done genetic mutation.