Surgery

Providence Saint John’s Health Center offers several types of breast cancer surgery as well as breast reconstruction for patients who desire it.

Lumpectomy/breast conservation surgery

This operation saves as much of the breast as possible by removing only the tumor plus a small surrounding area of normal tissue. It is an effective option for patients with Stage 0, I or 2 breast cancers. A lumpectomy for cancer can also be called segmental or partial mastectomy since part of the breast is removed and special attention is paid to margins.

  • Lumpectomy is almost always followed by radiation therapy to destroy any remaining cancer cells. In this procedure, only the cancerous breast tissue, with a rim of normal tissue around it, is removed.
  • The procedure is performed as an outpatient surgical procedure. Lumpectomy can be done while you’re under general anesthesia or monitored anesthesia. If your breast cancer is so small it’s not palpable, a guide wire has to be placed before the lumpectomy. Lumpectomy also preserves sensation in the breast, an important consideration for many women.

Whether or not you can undergo a lumpectomy depends on many factors including the size of your tumor, the size of your breast, the number of sites of cancer within the breast, and whether you can undergo subsequent radiation treatments. It is sometimes performed under local anesthesia, rather than general, depending on where your tumor is located.

Incisions are often small enough to be hidden, and once healed, may even be difficult to even see. With a lumpectomy, the nipple is almost always left in place.

Between 70 and 90 percent of women with newly diagnosed early-stage breast cancer are appropriate candidates for lumpectomy. For women whose cancers are too large for a lumpectomy to be performed without causing significant changes in the appearance of the breast, neoadjuvant chemotherapy is sometimes used to shrink the cancer before lumpectomy. Our team of surgeons, breast-imaging specialists, medical oncologists and radiation oncologists work together to ensure optimal outcomes for women who choose this treatment.

Mastectomy

This surgery includes the removal of the whole breast and possibly some lymph nodes. In most cases a mastectomy will mean that no radiation therapy is needed.

There are several different types of mastectomy depending on how whether skin or nipple is left behind and whether lymph nodes or muscle are removed.

  • Simple. This is the surgical removal of the breast, the nipple and most of the overlying skin and is also called a total mastectomy. The adjacent lymph nodes and chest muscles are left intact. If a few lymph nodes are removed, the procedure is called an extended simple mastectomy.
  • Skin-sparing. A skin-sparing mastectomy removes the breast tissue and nipple but leaves most of the overlying skin in place. Since the natural skin folds are left in place, the breast has a more natural look.
  • Nipple sparing. The breast tissue is removed but the overlying skin and nipple and areola are left in place. The patient's breast skin, areola and nipple remain. An advantage of this procedure is that the breast remains more cosmetically attractive. The disadvantage of nipple-sparing mastectomy is that the nipple and areola usually lose sensation.
  • Modified radical. Most of the lymph nodes in the axilla (axillary lymph node dissection, link to axillary lymph node dissection) are removed in addition to the mastectomy.
  • Radical mastectomy. Combines a mastectomy with axillary node dissection and the pectoralis (chest) muscle. This procedure also removes part of the chest wall because of chest wall invasion but is rarely required these days.

Depending on the stage and/or characteristics of the breast cancer or even patient age, some women are advised to undergo radiation therapy after mastectomy.

A patient who undergoes a mastectomy must decide whether she wants the breast to be reconstructed, and which type of reconstruction will work best for her. Breast reconstruction can be performed safely often during the mastectomy, or as a second procedure at any time following a mastectomy (even years later). If you’re considering breast reconstruction, be sure to tell your surgeons this prior to scheduling surgery.

Providence Saint John’s breast cancer surgeons offer innovative reconstructive techniques for women who have undergone a mastectomy. A major advance in breast reconstruction, called nipple-sparing mastectomy, may be appropriate for some patients. In this procedure, the surgeon removes the inner breast tissue, leaving a shell of skin and the nipple in place. The shell is then filled with tissue from the woman's abdomen or a tissue expander is placed beneath the chest muscle. This approach results in a more natural-looking breast. There will still be sensory changes and the nipple will not become erect or function like a normal nipple, but this approach can provide excellent cosmetic results. 

Lymph node dissection

Examining the lymph nodes gives us a better idea about the possible spread of the cancer throughout your body. If cancer is found in the lymph nodes it may indicate an increased risk for cancer in other parts of your body.

During lumpectomy or mastectomy, we remove one or more lymph nodes under the arm, and a pathologist then looks at them closely to see if the breast cancer has spread. Sentinel lymph node biopsy saves many patients from the most troublesome potential side effect of more extensive surgery — lymphedema, or swelling of the arm. This procedure was developed by the surgeons at Providence Saint John’s Health Center.

If the sentinel lymph node(s) are free of cancer, the remaining axillary lymph nodes are left alone. If the sentinel lymph node(s) contain breast cancer cells, removal of the remaining axillary nodes – known as axillary node dissection – is no longer necessary in most patients undergoing lumpectomy surgery. Axillary node dissection is still necessary for patients undergoing mastectomy and whose sentinel lymph nodes contain cancer cells.