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Facing early-stage breast cancer: Your options

There’s a reason women are urged to get regular mammograms: Finding breast cancer in its early stages increases the chances of successful surgical treatment. Breast cancer surgeries fall into two categories: breast-conserving surgery, in which the tumor is removed and most of the breast tissue remains, and mastectomy, in which the entire breast is removed. But in some cases, one option works equally well as another, and the choice will depend on personal preference.

Breast-conserving surgery

This type of surgery, also called lumpectomy, removes only the tumor, sparing the breast. Your surgeon will remove the cancerous tissue along with some surrounding healthy tissue to increase the chances of removing all the cancer cells.

Women who have a lumpectomy generally also undergo radiation treatments, beginning three to four weeks after surgery and continuing five days a week for five or six weeks. Lumpectomy with radiation offers the same survival success as mastectomy.

Breast-conserving surgery may not be your best option if you:

  • are pregnant (radiation can harm your unborn child)
  • have two or more tumors or your tumor is very large
  • had previous breast radiation
  • have a strong family history of breast cancer or you carry a gene mutation that indicates high risk for developing another cancer
  • have a connective tissue disease like scleroderma or rheumatoid arthritis
  • live too far from the radiation facility to attend daily treatments for six weeks

What to expect. A lumpectomy can often be performed on an outpatient basis with local, regional or general anesthesia. You probably won’t need to stay overnight unless you have lymph nodes removed, too. Your incision will be closed with stitches that dissolve on their own or are removed later, and covered with thin adhesive strips that will loosen and fall off by themselves.

Many women feel tightness or numbness, particularly under the arm, but excessive pain is unlikely.

Mastectomy

In this operation, surgeons remove the entire breast, including the lobules, milk ducts, fatty tissue and a strip of skin with the nipple and areola. Several types of the surgery are performed, depending on the cancer’s extent, and may include removing lymph nodes, chest wall muscles, fat and skin tissue. Some procedures aim to conserve as much of the chest wall and skin (sometimes even the nipple) as possible to limit disfiguring and allow for a better breast reconstruction. Your doctor may order presurgery chemotherapy or hormone therapy to shrink the tumor and allow for a less radical operation.

What to expect. Although the mastectomy may take only one to three hours, plan to spend a day or two in the hospital. Your surgery may be longer if both breasts are removed and/or you have immediate breast reconstruction. Your incisions will be closed with stitches that dissolve or are removed later and thin adhesive strips that will come off on their own. Your surgeon may sew in one or two small plastic tubes where your breast was to drain accumulating fluid. These tubes are removed after a week or two.

Many women feel temporary or permanent numbness, especially under the arm, but don’t usually have excessive pain.

Your surgeon will discuss your treatment plan and whether you’ll need chemotherapy, radiation or other treatments. Your medical team will explain how to care for your incision, plan for breast reconstruction surgery and wear a prosthesis. A counselor may speak to you about coping with the emotional and psychological effects of the surgery.

Checking your lymph nodes

Whether you have a lumpectomy or a mastectomy, your doctor must look at the lymph nodes under your armpit to determine whether your cancer has spread. You may undergo a procedure called axillary dissection, in which the surgeon removes some or all of your underarm lymph nodes to examine under a microscope to look for cancer cells. Complications can include lymphedema (painful fluid buildup in the arm), infection and numbness.

The surgeon may perform a sentinel lymph node biopsy instead. The sentinel node is the first lymph node into which a tumor will drain. If the sentinel node is cancer free, then it’s unlikely your cancer has spread and removing more lymph nodes is unnecessary. To find the sentinel node, doctors inject a dye or a radioactive material into the breast to trace how the fluid travels from the tumor to the lymphatic system. Once identified, the sentinel node may be removed during a lumpectomy or mastectomy for examination. If it contains cancer cells, your doctor can then remove more lymph nodes to determine the cancer’s spread.

Rebuilding your breast

Many women decide to have breast reconstruction surgery following a mastectomy. This surgery uses breast implants or some of your own tissue to reconstruct a naturally shaped breast. You may have this surgery at the same time as your mastectomy or months or even years later.