Individualized breast care is important to you and to us. This means that the choice of surgical procedure is very individualized. The most common types of procedures used to diagnose breast masses—cancers and non-cancers are:
In this procedure, the entire area of abnormal breast tissue is removed along with an area of normal, healthy appearing tissue around it. This area of normal, healthy appearing tissue is called a ‘margin’. This type of biopsy can be used for masses that can be felt, very small masses that cannot be felt or calcifications seen on your mammogram. The entire specimen will then be sent to the laboratory for microscopic examination and final diagnosis by the pathologist.
Calcifications or small masses seen on a mammogram are so tiny or deep within the breast tissue that they cannot be felt. Because these small masses and calcifications cannot be felt by the surgeon, he will need assistance in locating them to know exactly where to operate. This is done using a specialized procedure known as wire localization.
With wire localization, using your mammogram as a guide, a small needle is inserted into your breast and used to guide a special fine gauge wire into the abnormal area. Once this wire is in place, your surgeon can use this wire as a guide to the exact area of concern. He will remove the tissue surrounding the wire as well as a margin of healthy appearing tissue around it. Before you leave the operating room, x-rays of the specimen will be taken to assure that the surgeon has removed enough tissue. The specimen will then be transported to the laboratory for microscopic examination and final diagnosis by a pathologist.
Lumpectomy or ‘breast conserving surgery’ is used to remove a breast cancer. Only the cancerous area and a margin of healthy appearing tissue around it are removed. Generally, some of your underarm lymph nodes are also removed. The pathologist can then determine if the cancer has moved out of the breast and into these lymph nodes. This is important because treatment for breast cancer that has moved to the lymph nodes is different than if the cancer is only in the breast tissue. Generally after lumpectomy, you will need to have radiation therapy to your breast to destroy any cancer cells that may remain in the breast but cannot be detected. Radiation therapy usually lasts five to six weeks and is given five days a week.
A mastectomy removes the entire breast as well as some of your underarm lymph nodes. Generally, radiation therapy is not needed with a mastectomy.
Lumpectomy vs. Mastectomy
The decision between these surgical procedures is very personal and can be very difficult. The advantage of lumpectomy is that it preserves the breast. The disadvantage is the need for several weeks of radiation therapy following surgery. However, some women who choose mastectomy will still require radiation therapy based on the characteristics of their cancer. For small cancers and larger cancers that have not spread to the lymph nodes, the survival rate for lumpectomy with radiation therapy and mastectomy patients is the same.
Some questions you may ask yourself to choose between lumpectomy and mastectomy include:
- How do you feel about losing your breast?
- Will you be able to travel to and from radiation therapy?
- Will you be willing to have additional surgery to reconstruct your breast after mastectomy?
- What is the recovery time for each surgical option?
It is very important that your questions be addressed. It may be helpful for you to keep pencil and paper handy so that you can write them down so you don’t forget them. Bring your list of questions with you to your appointments. Bringing someone with you to your appointments often helps by relaxing you which aids you in remembering information given to you by your doctor. They may also ask questions that you had not thought of. There are breast cancer survivors and a breast cancer support group that may be helpful to you. There are many excellent references in our Cancer Resource Center.