The Most Recommended Treatment
Breast cancer surgery is an operation performed on the affected breast that is often combined with other treatments such as radiotherapy or chemotherapy. Surgery is the most frequently recommended treatment not only for eliminating a very large number of cells that form the cancerous tumour in the breast, but also for determining if the disease has spread to the lymph nodes, and for treating a relapse.
There are two possible types of surgical operation that can be performed under general anesthesia:
- partial mastectomy, also called tumorectomy, breast-conserving surgery, excisional biopsy, or quadrantectomy, involves removing the tumour and part of the normal tissues around it (the margin) to ensure they do not contain cancerous cells. While this procedure makes it possible to preserve as much of the treated breast as possible, it must nevertheless be followed by radiotherapy;
- total mastectomy, also called complete breast removal, consists in removing the entire affected breast. Most women can plan on having breast reconstruction performed either during the operation itself or at a later date through a cosmetic procedure.
In both cases, during the operation, the surgeon usually removes a few lymph nodes from the underarm (axillary region) on the side where the cancer is present. Examining these lymph nodes will reveal if the cancer has spread to the nodes and from there to the rest of the body. Based on the results chemotherapy may or may not be prescribed.
The methods used most frequently for checking the lymph nodes are axillary dissection and sentinel lymph node biopsy. The removal of lymph nodes from the underarm can cause an accumulation of body fluid (the lymph) and swelling in the arm and hand. This is called lymphedema. Other complications can result from surgery and the sooner these changes are reported to your medical team, the better they can be treated.
Depending on the precise location and the size of the tumour, the doctor will recommend either a partial or a total mastectomy to the patient. He could also present both operations as equally viable options, by describing the pros and cons of both. In the end, the decision is up to the patient, which is why it is important to understand the specific effects of both mastectomies.
The main advantage of a partial mastectomy is that it preserves the breast. However, radiotherapy needs to be done to ensure that any cancerous cells remaining in the breast are destroyed.
Moreover, partial mastectomy may cause the following side effects:
- the shape of the operated breast may change when a lot of breast tissue is removed to ensure that a healthy margin free of all cancerous cells is left behind. In this case the patient may plan to have breast reconstruction surgery (an operation that restores the breast to its original shape). The breast may also get swollen after the operation and be slightly larger for a period of time;
- loss of sensation may be felt in part of the operated breast, depending on the size of the tumour removed. Sensation may partially or completely return later.
Total mastectomy means removing the breast in its entirety. This procedure can undermine a woman’s sense of femininity which is closely connected to her self-esteem, seduction, sexuality and motherhood.
It’s a treatment that may call for reflection and discussion. Don’t hesitate to ask questions or to confide in your loved ones and medical team about your concerns. Make sure to get a thorough explanation of the advantages and limitations of this procedure.
Women dealing with breast cancer do not all react the same when faced with the prospect of losing a breast. Age, the personal situation and general state of health, as well as the stage of the cancer, are all factors that influence a patient’s decision about whether or not to have a total mastectomy.
For instance, some women are reassured by the fact that the tumour has been removed radically and that radiotherapy is often not necessary. For others, total mastectomy is the only possible option to eliminate the breast cancer.
In fact, doctors recommend a total mastectomy to women with breast cancer:
- who have more than one cancerous tumour in their breast; or
- whose tumour is large compared to the size of the breast; or
- who do not want or cannot have radiotherapy; or
- who choose this operation for greater reassurance.
Total mastectomy requires installing a surgical drain to eliminate the fluid that accumulates around the incision. In general this drain is removed one week after the operation. In some cases, however, the incision may swell and the blood or clear liquid that accumulate around the incision has to be drained through a simple procedure.
Total mastectomy may cause the following side effects:
- loss of sensation or pain felt in the skin around the incision, due to severed nerves. This is very common but usually temporary;
- extreme sensitivity to touch in the area of surgery caused by irritated nerve endings. This is also temporary and will improve over time;
- infection of the wound, that can be quickly and effectively treated with antibiotics;
- slow healing of wound, as the blood vessels in the breast tissue were severed during the surgery, the blood could not flow to the incision area. However this is rare and does not affect the outcome of the operation;
- pain, nausea, or loss of appetite; temporary effects that can be alleviated with the appropriate medication.