Surgery for Breast Cancer
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Surgery as Initial Treatment
For women with ductal carcinoma in situ (DCIS), surgery is always the first step in treatment. Biopsy slides and breast X-rays are reviewed at Fox Chase to confirm the diagnosis and provide the detailed information needed for treatment planning. An initial appointment is scheduled with one of our surgeons to discuss treatment options. Appointments with a plastic surgeon (reconstruction specialist) or radiation oncologist are arranged as needed.
Most women with invasive breast cancer undergo surgery to remove the cancer as their first treatment. Breast-sparing treatment is as effective in curing early stage breast cancer as mastectomy. Most women are candidates for breast conserving surgery; some are not. For these women, breast reconstruction at the time of mastectomy is usually an option. Our surgical team is dedicated to providing women with a complete range of options best suited to their individual needs.
Surgical Options for Women with Early Stage Breast Cancer
Lumpectomy, or breast-sparing surgery, is a procedure in which the surgeon removes the cancer and a margin of normal tissue surrounding the cancer. This is known as breast-conserving surgery and is followed by radiation therapy if the cancer is invasive. Surgeons determine how much breast tissue to remove based on the size of the tumor. For women with larger cancers, drugs can be used to shrink tumors prior to surgery making breast conserving surgery possible for more women.
Mastectomy is the complete removal of the breast tissue, including the nipple, but not the muscles of the chest wall. This operation is called a simple or total mastectomy. Mastectomy is performed on women who are not candidates for lumpectomy or who prefer to be treated by mastectomy.
Choosing Between Lumpectomy and Mastectomy
Women who choose lumpectomy and radiation can expect the same chance of survival as those who choose mastectomy. The advantage of a lumpectomy is that it saves the appearance of the breast. A disadvantage is the need for several weeks of radiation therapy after surgery. However, some women who have a mastectomy will still need radiation therapy.
Is surgery right for you?
Although most women and their doctors prefer lumpectomy and radiation therapy, your choice will depend on a number of factors, such as:
- Whether you want to devote the additional time and travel for radiation therapy
- How you feel about losing your breast
- Whether you would want to have more surgery to reconstruct your breast after having a mastectomy
In determining the preference for lumpectomy or mastectomy, be sure to get all the facts. Though you may have a gut feeling for mastectomy to "take it all out as quickly as possible," the fact is that doing so does not provide any better chance of long-term survival or a better outcome from treatment in most cases. According to research studies spanning 2 decades, mastectomy does not provide a better chance of survival than lumpectomy.
A lumpectomy (breast conserving surgery) and radiation therapy are not an appropriate option in some situations.
- Previous radiation to the breast or chest
- Being pregnant
- Presence of breast cancer in several areas of the breast
- Widespread, suspicious areas of calcium in the breast (called calcifications)
- Tumor at the margin of the lumpectomy that cannot be treated with repeat breast-conserving surgery
- Active connective tissue disease such as scleroderma or lupus
- Tumor that is large in relation to the size of the breast that did not shrink with chemotherapy or hormonal therapy before surgery
Advanced-Stage Breast Cancer Treatment
When cancer spreads, or metastasizes, from the breast, it often does so through the body's lymphatic system. If the lymph nodes contain cancer, the patient may need additional treatment following surgery, such as chemotherapy.
Fox Chase surgeons specialize in a conservative procedure called sentinel lymph-node biopsy, which spares patients from having extensive surgery to determine if the lymph nodes are cancerous. This outpatient procedure has fewer side effects with a more rapid recovery, allowing patients to return to their normal activities sooner.
For more information about breast cancer treatment and prevention at Fox Chase Cancer Center or to make an appointment, call 1-888-FOX CHASE (1-888-369-2427). The breast cancer scheduling department can be reached at 215-728-3001.