Surgery options

Surgery is one part of a treatment plan for early stage breast cancer. Surgery removes the disease in a local manner. Local treatment for breast cancer involves removing the cancer. That can be accomplished via lumpectomy or mastectomy. In general, radiation is given 4-6 weeks after a lumpectomy to reduce risk of recurrence. Not many people need radiation after a mastectomy unless the tumor is very large or if there are lymph nodes involved, skin involvement, or chest wall involvement. At the time of either lumpectomy or mastectomy, a sentinel node biopsy is performed for a diagnosis of invasive cancer to make sure the tumor has not spread to the lymph nodes. Sometimes an axillary dissection (complete removal of the lymph nodes) is performed if there is a lot of cancer in the lymph nodes. 

Mastectomy is surgery that involves complete removal of the breast tissue. You may choose to have a mastectomy for personal reasons, genetic mutation (prophylactic surgery aka risk-reducing surgery), high-risk for breast cancer, large tumor, tumor involves the nipple, inflammatory breast cancer, wanting to avoid radiation, pregnancy, etc.

If you have invasive cancer and lymph nodes do not appear to be involved on exam and/or on ultrasound, then a sentinel node biopsy may be performed at the time of surgery. Even though imaging may show no involvement of cancer in the lymph nodes, microscopic cells are not picked up on imaging. Therefore biopsy is performed to be assessed microscopically. The day of surgery you will have a dye or radioactive tracer injected at the tumor or around the nipple. This will travel through the lymphatic system and light up the sentinel nodes. The sentinel nodes are the first nodes to be affected IF cancer were to have traveled there.  

If there appears to be a lot of cancer involved in the lymph nodes either on exam or on imaging or after a sentinel node biopsy, you may have to have an axillary dissection or complete removal of the lymph nodes under the arm.

If you have either a lumpectomy or a mastectomy you may be candidate for reconstruction with a plastic surgeon. 

For a lumpectomy, a plastic surgeon can perform a symmetry procedure on the other side via a reduction mammoplasty or tissue rearrangement. 

For a mastectomy, a plastic surgeon can perform implant based reconstruction or autologous reconstruction. Implant-based reconstruction involves placing either an expander (balloon-like apparatus) or the implant right away. If an expander is placed, a second procedure will need to be formed a few months out to replace the balloon with an implant. Autologous reconstruction involves taking a patient's own tissue and recreating a breast. This surgery is more involved and the recovery time is longer than with implant-based reconstruction.