Breast Surgery:

Many women with breast cancer undergo complete or partial breast removal to treat the disease. Additionally, women may undergo lymph node removal in the armpit area to prevent the spread of the tumor, as breast cancer often spreads through the lymphatic vessels.

Reasons for needing surgery:

Surgical procedures may be necessary for:
1- Removing as much of the tumor as possible (breast-conserving surgery or mastectomy).
2- Determining if the cancer has spread to the lymph nodes (by taking a biopsy of the sentinel lymph node and examining it or dissecting the axillary lymph nodes).
3- Breast reconstruction following tumor removal.
4- Alleviating symptoms of advanced cancer.
After being diagnosed with breast cancer, a joint decision will be made between you and your doctor to choose the most suitable surgical procedure based on your medical history and condition. Sometimes, the doctor may offer you a choice of procedures.

Types of breast surgeries:

1- Breast-conserving surgery: This involves removing the cancer (tumor) with small amounts of surrounding healthy tissue, depending on the tumor’s location and size. This surgery is also known as partial mastectomy, quadrantectomy, or lumpectomy.
2- Total mastectomy: This procedure involves removing all the affected and healthy breast tissue, and sometimes adjacent tissues depending on the tumor’s spread. The doctor may also perform a double mastectomy, which involves removing both breasts.
The procedure varies based on your health condition. If the tumor is large and has spread, or if you have previously received radiation, a total mastectomy may be the best or only solution. If breast cancer is detected early, you have the option to choose between the two types of surgery. Women who undergo early complete breast removal are less likely to need radiation therapy. However, the doctor may combine various surgical, radiation, and chemotherapy treatments to determine the tumor type and prevent its spread.
You may also need surgery to remove the nearby lymph nodes, including the axillary nodes that receive lymph from the breast. There are two types of surgery:
1- Sentinel lymph node biopsy: In this procedure, a specific dye is injected, and then the lymph nodes that initially took up the dye (the nodes that receive lymph first) are removed. They are then examined for the presence of cancer cells. This procedure is safer than the routine removal of lymph nodes, as it reduces complications, including lymphedema.
2- Axillary lymph node dissection: In this procedure, no dye is used, and multiple lymph nodes are removed and examined.

Complications and side effects you may experience after surgery:

If you undergo tumor removal surgery only, you may experience:
1- Numbness along the entire length of the incision.
2- Swelling and sores on the chest, underarm, and shoulder.
If you undergo complete breast removal surgery, you may experience numbness in the chest from the collarbone down the length of the chest. This numbness may not resolve, and you may also feel pain in the chest, shoulder, and armpits. Numbness may extend to your arm if the lymph nodes under the armpit are removed. Additionally, the risk of lymphedema (fluid buildup in the arm) in the hand, fingers, chest, or back is increased.
During complete breast removal surgery, the doctor may use artificial breast implants made of silicone or other materials to compensate for the loss of natural breast tissue for cosmetic purposes. The surgeon will leave the skin as flat as possible to accommodate the artificial breast. It can be placed in a bra or directly on the skin with an adhesive patch and can be fitted weeks after breast removal surgery. Inform your doctor to discuss options for artificial breasts if you notice different side effects.

Removal of the other breast to reduce the risk:

Contralateral (preventive) breast removal is performed to reduce risks when a person has cancer in only one breast but both breasts are removed as a preventive measure. It is usually done in the same surgery and aims to protect women at high risk of developing breast cancer. There are also cosmetic goals for removing the contralateral breast to create balance with the removed breast. Doctors work to minimize all possible routes of tumor spread, so consult your doctor for the best option for your health.

Surgical Procedure Details:

The doctor will administer general anesthesia, so you will be asleep during the surgery. They will then perform a complete removal of the breast tissue (in a total mastectomy), including the areola and nipple. The skin will be closed with stitches and drains (1-2 tubes) will be placed to allow fluid to drain. The drain will remain in place for a week to 10 days after the surgery.
The doctor will send tissue samples that have been removed for examination. It may take a week or two for the results to come back. Pathology results may indicate the presence of more cancer cells at the closest margin to the chest wall, suggesting the need for further surgery.

Breast Reconstruction Surgery:

Some women choose breast reconstruction surgery to help restore the appearance of the removed breast. This procedure can be immediate (done during the mastectomy) or delayed (done at a later time). Generally, the results of reconstructive surgery with immediate breast reconstruction should be discussed with a plastic surgeon who will help make the appropriate surgical decision. Talk to them about the available options for you.The doctor will send tissue samples that have been removed for examination. It may take a week or two for the results to come back. Pathology results may indicate the presence of more cancer cells at the closest margin to the chest wall, suggesting the need for further surgery.