Breast surgery can be performed to remove known or expected benign lump or to remove cancer. In the first instance it is called an exisional biopsy. Lumpectomy and mastectomy are procedures used to remove cancer.
For more information or to contact:
Sarah Burkett, LPN
160 North Eagle Creek Drive, Suite 101
Lexington, KY 40509
There are three situations in which a surgical excisional biopsy may be performed:
- Prior needle biopsy indicating high risk lesion/abnormality which needs to be removed in entirety.
- Abnormality on mammogram or ultrasound that is not amenable to needle biopsy for diagnosis.
- Large masses that are presumably benign (not cancer) but, due to the large size, necessitate removal.
This procedure involves a small incision in the breast and the removal of the area of interest. If area of concern cannot be palpated by the surgeon, a needle/wire localization will be performed prior to surgery. Excisional biopsies are performed as outpatient surgery. Patients will usually be able to return to work and other activities within five days.
If a breast abnormality (biopsy proven cancer or suspicious area not amenable to needle biopsy) needs to be removed surgically with either lumpectomy or excisional biopsy a needle/wire localization procedure is needed if the abnormality cannot be felt/palpated by the surgeon.
This procedure is performed on the day of the surgery by the radiologist.
Typically, the patient registers for surgery at the hospital and is then transported to Breast Care for the localization. After the breast is cleansed and numbed, using either ultrasound or mammogram imaging for guidance, a needle/wire device is placed through the skin with the wire tip placed adjacent to the abnormality. This provides a precise "roadmap" for the surgeon to subsequently remove the abnormality. Mammogram image is usually obtained at the completion of the localization procedure and then the patient is transported back to the operating room.
Lumpectomy, or breast conservation surgery, includes removal of the cancerous lump plus a rim of normal tissue to insure that all cancer cells are removed. The procedure is performed as outpatient surgery.
Once the breast heals almost all patients will be treated with radiation. It has been well documented that the combination of lumpectomy and radiation therapy offers the same prognostic benefit as mastectomy.
The patient having lumpectomy will usually be able to return to work and other activities within five days.
Mastectomy means removal of all the breast tissue. This operation has evolved greatly over the last thirty years. Mastectomy involves removal of the breast tissue but not the underlying muscle and ribs, as was done until the 1960's. Many women choose to have breast reconstruction surgery after mastectomy and most insurance companies will cover this surgery.
Many mastectomies can be performed as outpatient surgery. Some patients will require hospitalization.
The recovery time is longer than that for a lumpectomy. The patient will be evaluated by the surgeon one week after mastectomy to determine when she can return to work and other normal activities.
Sentinel Node Biopsy
If the breast cancer is invasive and there is no clinical evidence of tumor within the lymph nodes a sentinel lymph node dissection will be performed. The sentinel lymph node is the main lymph node that drains the breast. Before planned lumpectomy or mastectomy a substance is injected into the breast which then travels through the lymphatic system to the main draining lymph node. The substance is identified in the operating room and the surgeon is able to remove this lymph node through a small incision.
If metastatic spread to the lymph nodes in the armpit is clinically evident prior to surgery, many lymph nodes will be removed.
If a woman has mastectomy performed, reconstruction of the breast can be done at the same time the breast is removed or at a later time (perhaps months after the mastectomy). A plastic surgeon handles all aspects of breast reconstruction. There are two ways to reconstruct the breast - with an implant or by a flap procedure where tissue from another area of the body is repositioned to fashion a breast. If a woman needs to have radiation or chemotherapy, it is generally recommended this treatment be completed prior to reconstruction.
Lymphedema is caused by a buildup of fluid in body tissues. The lymph system collects excess protein and fluid from tissues and carries them back to the blood stream. At surgery, lymph nodes and the attached vessels may need to be removed. Following removal of several axillary (armpit) lymph nodes the flow of lymphatic fluid can be compromised resulting in swelling of the arm referred to as lymphedema.
Treatment for lymphedema is available through the Saint Joseph Specialty Center. While there is no cure, three certified lymphedema specialists can offer education on management of symptoms. Instruction in breast cancer recovery exercises is also available.
Please contact Saint Joseph Rehabilitation Department and Specialty Center (859.313.1792) for further information.