Breast Surgery

Breast surgeons on the medical staff employ many techniques to treat breast cancer surgically. When possible, they strive to preserve as much of the breast tissue as possible through lumpectomy (removal of the tumor with a rim of normal tissue). In certain instances, mastectomy (removal of the breast) is required.

A mastectomy is usually recommended if the tumor size is large compared to breast size, if there is more than one area of cancer in the breast, or if the patient cannot undergo radiation therapy. About four weeks after surgery, most patients undergo chemotherapy if the tumor removed is larger than 1 cm or if a lymph node is involved. Chemotherapy is given by a medical oncologist one day every three weeks for four to six months. If breast conservation therapy (a lumpectomy) is performed, patients undergo radiation therapy, which starts about one month after the last chemotherapy treatment is done. It is given every day for five to six weeks by a radiation oncologist. 

Breast Reconstruction is achieved through several plastic surgery techniques that attempt to restore a breast to near-normal shape, appearance, and size following a mastectomy. It can be a physically and emotionally rewarding procedure for a woman who has lost a breast due to cancer or other condition.For many women, creating a new breast can dramatically improve their self-image, self-confidence, and quality of life. Although surgery can give you a relatively natural-looking breast, a reconstructed breast will never look or feel exactly the same as the breast that was removed. Because breast reconstruction is often an important part of a woman’s total recovery, reconstructive surgeons on the medical staff offer quality care with attentive personal service.

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FAQs

Breast surgeons on the medical staff employ many techniques to treat breast cancer surgically. When possible, they strive to preserve as much of the breast tissue as possible through lumpectomy (removal of the tumor with a rim of normal tissue). In certain instances, mastectomy (removal of the breast) is required.

A mastectomy is usually recommended if the tumor size is large compared to breast size, if there is more than one area of cancer in the breast, or if the patient cannot undergo radiation therapy. It can also be recommended if a patient has a genetic mutation predisposing to breast cancer.  Ultimately this will be at the discretion of the patient and the physician.

Breast reconstruction is the process of rebuilding the breast after mastectomy surgery.  It is done by a plastic surgeon and is usually a staged process involving tissue expander placement at the time of mastectomy followed by either implant placement or tissue-based reconstruction at a second surgery. It attempts to restore the breast to near normal shape, appearance, and size following a mastectomy. Reconstruction can also be performed for lumpectomies in the event the area removed is a large defect.  This is called oncoplastic breast surgery/reconstruction where a lift/reduction technique is performed by a plastic surgeon to fill in the defect and leave a naturally lifted breast.

 

Insurance does cover reconstruction surgery after either lumpectomy or mastectomy.  This is not to be confused with breast augmentation surgery which is cosmetic implant placement, unrelated to breast cancer.

Radiation therapy can start as soon as three to eight weeks after surgery. However, if the patient needs chemotherapy after surgery this is given first.  Radiation will begin 3 to 4 weeks after the chemotherapy ends.  This is of course variable per patient and at the discretion of the patient’s physicians.

No, not all patients require chemotherapy.  This is based on tumor size, lymph node involvement, and type.  There are several factors that go into this decision and is ultimately at the discretion of the patient’s treating medical oncologist.

Endocrine therapy is an antiestrogen treatment and will be recommended for patients who have an estrogen receptor-positive tumor.  It is not chemotherapy, but rather an antiestrogen pill that helps deprive the body of residual estrogen to prevent tumor recurrence. The 2 main sources of estrogen in a woman’s body are the ovaries and adipose tissue, i.e. fat cells.  So even when a woman is in menopause, they still have low levels of estrogen-based on the amount of adipose tissue/fat cells they have. For this reason, it is recommended patients maintain ideal body weight after breast cancer treatment.

There are a variety of risk factors:

  1. Risks that you cannot change
    • Increasing age
    • Being female
    • Family history
    • Ethnicity
    • Genetics
    • Dense breast tissue
  2. Lifestyle-related risks – may increase the risk
    • Being overweight or obese
    • Not getting enough physical activity
    • Early menarche, late menopause, not having children or older age at first birth, not breastfeeding
    • Some hormone replacement therapy after menopause
    • Drinking alcohol

The guidelines depend on each patient’s risk level which is determined by the patient and their physician.

In general:

For those at high risk

  • Monthly breast self-exams
  • Routine clinical breast exams
  • Yearly screening mammograms (possibly at an earlier age)
  • Possibly yearly screening MRI

For those with routine risk:

  • Monthly breast self-exams
  • Routine clinical breast exams
  • Screening mammograms every year starting at the age of 40