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U.S News Tops Docs 2012

Types of Breast Surgery

Breast-Conserving Surgery | Mastectomy | Breast Reconstruction | Lymph Node Surgery

Most breast cancers are diagnosed pre-operatively by an image-guided core needle biopsy. Sometimes, if the results of the core needle biopsy are not definitive, surgery is performed to rule out or diagnose breast cancer (diagnostic open surgical biopsy). In breast cancer, the purpose of surgery is to remove all of the cancerous cells. Surgery is also performed to find out whether the cancer has spread to the lymph nodes under the arm.

Treatments exist for every type and stage of breast cancer. Talk with your doctor to learn as much as possible about your surgical treatment options. Just as no two women are the same, no two breast cancers are the same, and it is important to try to understand what is the best choice for you. The following is a summary of the most common types of breast surgery.

Open surgical biopsy

Excisional biopsy
Excisional biopsy

The surgeon removes a small segment of breast tissue for further pathologic evaluation. This is similar to a lumpectomy, but is done in cases where there is no pre-operative diagnosis of breast cancer. Typical examples include patients who present with a palpable lump not seen on imaging, nipple discharge, or abnormal imaging that is indeterminate. This is a diagnostic operation. If cancer is found, you may need additional surgery for treatment.


Wire-localized excisional biopsy
Wire-localized excisional biopsy

In cases where the lesion cannot be felt by the surgeon, a radiologist can help by placing a thin wire into the abnormal area to guide the removal of the affected area. This is generally done several hours before surgery under local anesthesia by the radiologist. The wire is removed at the time of surgery.

Breast-Conserving Surgery

Lumpectomy/ Segmentectomy/ Segmental mastectomy
Lumpectomy/ Segmentectomy/ Segmental mastectomy

Lumpectomy is the most common form of breast cancer surgery today. The surgeon removes the segment of the breast containing the tumor (or “lump”) and some of the normal tissue that surrounds it (called a “margin”). In general, lumpectomy is almost always followed by radiation therapy to destroy any remaining cancer cells. The combination of lumpectomy and radiation is commonly called breast-conservation therapy (BCT).

Wire-localized lumpectomy/ Segmentectomy/ Segmental mastectomy
In cases where the tumor cannot be felt by the surgeon (not palpable), a radiologist can help by placing a thin wire into the abnormal area to guide the removal of the affected area.  This is generally done several hours before surgery under local anesthesia by the radiologist.  The surgeon then removes the segment of the breast containing the tumor (or “lump”) and some of the normal tissue that surrounds it (called a “margin”). 

Oncoplastic breast-conserving surgery
A new emerging specialized type of lumpectomy performed in cases where the location or size of the tumor would lead to a suboptimal cosmetic result.  In these cases, the breast surgeon can use an oncoplastic approach that involves a lumpectomy followed by local advancement of the remaining breast tissue to fill in the surgical defect.  This effectively immediately reconstructs the breast to help achieve a better cosmetic outcome.  The resulting breast is often “lifted.”  Examples include batwing mastopexy, donut mastopexy, and reduction mastopexy.  Studies have shown that oncoplastic lumpectomies result in resection of a larger volume of breast tissue with larger margins.  Radiation therapy is still necessary afterwards to destroy any remaining breast cancer cells. Oncoplastic breast-conserving surgery

Mastectomy

Total (simple) mastectomy
SImple MastectomyIn this procedure, the surgeon removes all of the breast tissue, including the nipple and areola, but does not take out any lymph nodes. No muscle is removed.

Modified radical mastectomy (total mastectomy and axillary node dissection)
This operation involves removing all of the breast tissue, including the nipple and areola, as well as some of the lymph nodes under the arm (see Axillary lymph node dissection). No muscle is removed.

Skin-sparing total mastectomy
Nipple Sparing Mastectomy A special form of a simple mastectomy where all of the breast tissue including the nipple and areola is removed through a limited circumareolar incision (see illustration), thus allowing preservation of as much of the native breast skin as possible. This specialized approach facilitates immediate breast reconstruction by preserving the natural shape and contour of the breast. Multiple published series have shown that using a skin-sparing approach in cases where immediate breast reconstruction is planned leads to high rates of patient satisfaction and long-term oncologic safety.
Nipple-sparing total mastectomy
A highly specialized form of a simple mastectomy where all of the breast tissue is removed, while preserving the nipple and areola.  Limited studies have shown that a nipple-sparing approach may be safe in highly selected patients who are motivated to keeping their nipple areolar complexes.  This approach has been slow to gain popularity in the United States, due to lack of preservation of nipple sensation, problems with nipple viability (blood supply), difficulty in achieving symmetry during reconstruction, and a theoretical increased risk of breast cancer recurrence due to preservation of ductal tissue behind the nipple.If you are interested in saving your nipple and areola, ask your surgeon for more details regarding the long-term safety of this procedure to see if you are a candidate.

For information on breast reconstruction, please click HERE

For information on lymph node surgery, please click HERE

 

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