Our fellowship-trained breast surgeons at the Margie Petersen Breast Center at Providence Saint John’s Health Center offer the most advanced surgical breast care available, including oncoplastic lumpectomy/partial mastectomy surgery, extreme oncoplastic surgery, sentinel node biopsy, and skin-sparing and nipple-sparing mastectomy with breast reconstruction for patients who desire it.
Lumpectomy or Partial Mastectomy
Breast-conserving surgery (also known as lumpectomy or partial mastectomy), aims to preserve as much of the breast tissue as reasonably possible. This is an effective option for patients with early stage breast cancer. In this procedure, only the cancerous breast tissue, along with a small area of normal tissue surrounding it, is removed. While this is often preferable, breast-conserving surgery is not possible for all situations. Breast-conserving surgery is generally followed by radiation therapy. It is important to understand that breast-conserving surgery has been shown to be just as effective as mastectomy in terms of survival. Breast-conserving surgery is generally performed as an outpatient surgery under mild sedation.
Whether or not you can undergo breast-conserving surgery depends on many factors including the size of the cancer, the size of your breast, the number of sites of cancer within the breast, and whether you can undergo subsequent radiation treatments. Incisions are often small enough to be hidden, and once healed, may even be difficult to even see. With breast-conserving surgery, the nipple is almost always left in place.
Oncoplastic surgery is a different approach to breast-conserving surgery. With oncoplastic surgery, specially trained breast surgeons use traditional plastic surgery incisions and techniques to perform the partial mastectomy. The benefit of oncoplastic surgery is to allow for wider removal of cancer with immediate reshaping of the breast tissue to provide an optimal cosmetic result. This approach has been shown to reduce the need for multiple operations to completely remove the cancer and is a useful tool for removal of a larger cancer in patients who may otherwise have been advised to have a mastectomy.
This is a good option for patients who are also candidates for breast reduction or mastopexy (breast lift). The opposite breast may also be modified to create symmetry.
Mastectomy is a type of surgery that removes the majority of the breast tissue. Breast tissue extends from just below the collar bone to the fold under the breast, and from the breast bone to the side of the chest wall. When a mastectomy is performed, every effort is made to remove as much breast tissue as possible.
However, there will be some residual breast tissue left under the skin. Mastectomy does not completely eliminate the risk of future breast cancer but will reduce the risk significantly, to 1-3%. Radiation therapy can often be avoided in patients who have mastectomy. Some patients with more advanced disease may still need radiation therapy after mastectomy.
Types of Mastectomy
During this surgery the entire breast, nipple and some skin are removed. This surgery is performed when the area of cancer is too large for breast-conserving surgery or for patients who cannot or will not have radiation therapy, or for men with breast cancer.
This is usually done when patients are not interested in immediate reconstruction. Skin is removed so the patient is not left with excess skin after surgery. Breast reconstruction can still be done at a later date to restore the appearance of the breast mound.
Skin-sparing mastectomy removes the underlying breast tissue and nipple and as little breast skin as possible. This leaves the breast skin envelope so that breast reconstruction can be performed with a better cosmetic result. This is always performed as part of a plan for reconstruction by the plastic surgeon.
Nipple-sparing mastectomy is an operation that removes the entire breast. However, the skin envelope and the nipple are preserved in an attempt to preserve the appearance of the breast. The breast tissue is removed, but the overlying skin and nipple and areola are left in place.
An advantage of this procedure is that the breast remains more cosmetically attractive. The disadvantage of nipple-sparing mastectomy is that the nipple and areola usually lose sensation.
Modified Radical Mastectomy: (Total mastectomy with axillary lymph node dissection)
During this procedure the entire breast and the lower level underarm lymph nodes are removed. The chest muscle is left intact. Breast reconstruction may be done by a plastic surgeon at the time of surgery or in the future to restore the appearance of the breast.
Lymph Node Surgery
For patients with invasive cancer of the breast, evaluation of the lymph nodes in the armpit (axilla) is a critical component of the surgical procedure. Since breast cancer can spread through the lymphatic system, axillary lymph node surgery is the best way to determine if the cancer has spread beyond the breast.
With this technique, usually only one or two lymph nodes are removed, so the surgery is less invasive, has fewer complications, and allows a quicker recovery. This procedure can be performed along with either lumpectomy or mastectomy.
This procedure is performed when there is biopsy-proven spread of cancer to the lymph nodes under the arm. A portion of fatty tissue under the arm containing lymph nodes is removed. The lymph nodes are separated from the fat and individually examined under the microscope by our pathologist. An average of 10 to 20 nodes are removed.
Our team of surgeons, breast-imaging specialists, radiation oncologists, and medical oncologists work together to ensure our patients are supported in choosing the best option for them for optimal outcomes.
One of the most significant complications of axillary lymph node dissection is lymphedema, or abnormal swelling of the arm or hand from impaired lymph drainage. It can develop immediately following surgery or even years later. Some patients also report swelling in the breast or chest wall. It may occur following removal of some or all of the axillary lymph nodes, or those lymph nodes in the armpit, or after radiation treatments directly to those nodes.
It occurs when lymphatic vessels of the arm are no longer able to remove all the lymphatic fluid that is normally filtered from the tissue. Sometimes lymphedema is triggered by an injury, infection, burn, or other trauma to the arm. Studies have also shown that weight gain after treatment for breast cancer can strain the lymphatic system.
The Providence Saint John’s Health Center team of specialists includes physical therapists specially trained in treating lymphedema.