Types of Breast Surgery - dummies

By Marshalee George, Kimlin Tam Ashing

So, you’re thinking about breast surgery — or perhaps surgery is already scheduled. Deciding on the best type of surgery can be overwhelming and can pose a dilemma. The most common types of breast surgery include the following:

  • Lumpectomy (partial mastectomy): The tumor is removed from the breast along with a small border of healthy normal tissue.
  • Mastectomy (total or simple): The entire breast is removed.
  • Modified radical mastectomy: The entire breast and lymph nodes under the arm are removed.
  • Prophylactic mastectomy: Occurs when a person chooses to remove one or both breasts because of familial or genetic risk factors.
  • Mastectomy with reconstruction: This is where reconstruction is performed at the same time as removal of the breast. Many types of reconstruction include placement of a foreign material (implant or tissue expander) or use of your own tissue to reconstruct the breast.

    This figure illustrates how a tissue expander works.

    breast-tissue
    Illustration by Kathryn Born

    Tissue expander placed under skin and muscle and inflated with saline solution.

  • Sentinel lymph node biopsy: The surgeon injects a blue and/or radioactive dye under the nipple area (the subareolar region) several hours prior to surgery. After injection, the breast is massaged for a few minutes to allow the dye to be taken up by the lymphatic system. The path of the dye will represent the drainage pattern of that breast.

    During surgery the surgeon removes the tumor and, thanks to dyes, the surgeon is able to find whether any lymph nodes have picked up the dyes. The blue dye can be visualized with the eye, and the radioactive dye is tracked using an instrument called a gamma probe. The first lymph node to pick up both dyes is called the sentinel lymph node. The sentinel nodes are the first few lymph nodes into which a breast cancer or tumor drains. The blue dye gets from the breast tumor to the lymph nodes by way of the lymph fluid (blood plasma, proteins, glucose, and oxygen in the lymphatic vessels). The purpose of using the blue dye in sentinel lymph node biopsy is to identify the sentinel lymph nodes. Chapter 1 talks more about lymphatic vessels and lymph fluid.

    The surgeon typically removes one to three nodes for testing. After your surgery, the pathologist will determine whether or not cancer has spread to those sentinel lymph nodes. This will help determine whether you will need more surgery to remove all the lymph nodes (a completion axillary lymph node dissection) and/or chemotherapy or radiation.

    You may be worried about radiation exposure from the radioactive dye. Rest assured that the amount of dye and radiation is so small that it’s safe to use in pregnant women that have breast cancer. It’s equivalent to the amount of daily background radiation you get from the environment.

  • Axillary lymph node dissection: The surgeon removes most of the lymph nodes (levels one and two) from under the arm to determine how far the cancer cells have spread and to stop the spread. This procedure is done in large tumors or if there is known to be cancer in the lymph nodes (for example, after a positive result from a sentinel lymph node biopsy). Removing many of the lymph nodes under the arm increases your risk of having arm swelling, called lymphedema.