Types of Breast Cancer Surgery:
There is an important distinction between a diagnostic surgery, a surgical treatment and reconstructive surgery for breast cancer and understand the impacts on a survivor.
- Sentinel Lymph Node Biopsy (SLNB) – A diagnostic surgery to determine if a cancer has invaded the lymphatic system (e.g. spread beyond the tumor found in the breast). Such a determination is pivotal to a cancer patient’s prognosis as it helps prescribe a treatment plan. Almost all breast cancer survivors have a Sentinel Lymph Node Biopsy performed (as do most other cancer types). This outpatient procedure is usually done as one of the first procedures and sometimes be overlooked in terms of the physiological impacts it can cause. It is so important to understand that we will explore this procedure is more detail in Module #2 but it’s important to understand in relation to other surgeries and the common side effects.
- Lumpectomy: This treatment surgically removes the cancer cells and the surrounding tissue or the ‘surgical margin’. The scale or scope of this surgery varies based on the size, location and grade of the tumor. A goal of this procedure is to preserve the remaining breast tissue, shape and sensation.
- Mastectomy – Partial, Total or Double: Like the lumpectomy, this treatment surgically removes cancer cells but requires removal of the entire breast tissue and sometimes the chest muscles below the cancer are removed. There are various types of mastectomies that are used based on the size, location and grade of the tumor. Also, for very small population of breast cancer patients e.g. less than 1%, both breast are removed for preventive reasons due to specific genes (BRAC or H2Neu) being the cause of the cancer. Often specifics about the patient are considered like age, overall health, individual preferences and tolerance for other treatments.
- Reconstruction: Breast reconstruction is not treatment for cancer but an elective surgery. It is an aesthetic surgery to rebuild a breast based on individual preference. This procedure can be done in conjunction with a mastectomy treatment or done 6-12 months later. The breast or breasts are rebuilt using implants made of saline or silicone, or by using autologous tissue, which is self-harvested tissue from elsewhere in the patient’s body. Several sites on the body can provide the tissue for breast reconstruction and often tissue expanders are used to stretch the skin for the implants. The scale and requirements of any breast reconstruction is based on the individual’s preference and desired outcome. It’s important to point out that for autologous reconstruction the ‘donor’ site – abdomen, back, buttocks or thighs – will face side effects from surgery and removal.
Breast Surgery Location.
The location of breast cancer surgeries can be more debilitating than other cancer types and requires special exploration and understanding. Key points of consideration:
- The Sentinel Lymph Node is often located in the armpit of the side where the tumor has been found. That location is vital to understand for both the impact on range of motion and the impact to the lymphatic system (See Module #2).
- Surgical treatments greatly impact the strength, flexibility and range of motion of the pectoral muscles and tissue. This directly impacts quality of life and normal day functioning.
- Reconstructive surgeries not only impact the pectoral muscle and tissue but also the donor site for autologous grafting that can include the abdomen, back, buttocks and thighs. The combination with the pectoral muscle restriction can be very challenging and require life long management.
Surgery often is the first day of the survivor’s new job – to protect their immune system.
Every patient’s cancer treatment and protocol are different but most breast cancer patients start with the SLNB diagnostic surgery to identify the treatment protocol. Most often surgery is before radiation, chemotherapy or other treatments. (Please note in some cases chemotherapy or radiation is used to shrink a tumor prior to removal. NOTE: I don’t know we need this.. ) That is why we start with ‘post surgery management’ in this workshop. Moreover, that surgical procedure begins the cancer patient’s new job of protecting their immune system. That job can greatly impact recovery time, outcomes and survival.