Breast Cancer Surgery
Reviewed By : Dr. Aarti Joshi
Listed below is the step by step procedure of breast cancer surgery:
- What is Breast Cancer Surgery?
- Why is Breast Cancer Surgery Required?
- Pre-operative Preparation
- Day Before Surgery
- Procedure Day
- Methods/Techniques of Breast Cancer Surgery
- Post Procedure
- Risks and Complications
What is Breast Cancer Surgery?
Breast cancer is predominantly considered a female-specific disease. But uncontrolled cell growth to be converted to tumors can afflict men as well. Breast cancer surgery is required for removing tumors when in advanced stage and also when medication is not effective for curing the cancer. There are different types of surgery methods utilized for treating breast cancer. The stage at which cancer has reached decides the type to be used.
Breast cancer has been observed to be affecting women of any age above 30 years of age. It is the most common form of cancer in women.
Why is Breast Cancer Surgery Required?
Surgery is recommended only if and when the tumor is in advanced stage and when there is no other option besides operation. Surgery is also an option when neither medication nor therapy has worked out for eliminating the breast cancer. Following indicators may alert the doctor for using surgery for removing the breast cancer entirely from the body. It will prevent recurrence only if the entire breast tissue is removed.
- Signs of advanced cancer - Breast cancer surgery is helpful in alleviating slightest indications of cancer progressing to an advanced stage.
- Progression of cancer - Breast cancer surgery can help in detecting if the cancer has spread to parts like armpits.
- Elimination of cancer - Another goal of the surgery is of eliminating all signs of cancerous tumors entirely from the body.
When the above indications ring true in any patient's case, the surgery decision is confirmed for the patient. There are certain diagnostic tests that the patient is made to undergo before surgery. Few of them are as follows:
Biopsy and mammogram are the tests that help the doctor determine the type of surgery suitable for the patient. These tests help the surgeon in understanding the extent of metastasis (spread) of the breast cancer in the breast and remaining healthy tissues in the body. The breast tissues may also be examined before the surgery using Magnetic Resonance Imaging (MRI) for knowing the progression of the cancer.
Depending on the results of these diagnostic tests, the type of surgery required is decided and date for surgery is also then scheduled. Following given are the instructions patient needs to follow once surgery date is decided.
Day Before Surgery
Instructions to be followed on the day before undergoing surgery for breast cancer:
- Medication - You need to discuss with your doctor if you are on blood thinning medication for other conditions. Also, other drugs you have been prescribed need to be reported to the surgeon.
- Blood tests - The doctor may also make you undergo certain blood tests for checking the body's reaction.
- Food intake - Do not eat anything for minimum 8 hours before surgery.
- Pre-operative instructions given by your doctor - You need to follow the pre-operative instructions given by your doctor very carefully. Those instructions are for reducing even smallest chance of complications before and after surgery.
Instructions to be followed on the day of surgery for breast cancer:
- Water - Do not drink water at least 4 hours before the surgery.
- Pickup arrangement - Make arrangements for someone to pick you up after the surgery.
- Blood tests - Complete Blood Count and related blood tests are required to be done.
- Anesthesia - Doctor needs to verify whether patient is allergic to some type of anesthesia.
- Vital signs - Vital signs like heart and pulse rate are monitored before surgery starts.
Based on the findings of pre-operative diagnostic tests, any of the following methods will be utilized for performing breast cancer surgery.
Methods / Techniques of Breast Cancer Surgery
Treatment decided for the breast cancer differs according to the size and location of tumor. It is also dependent on the extent to which cancer has metastasized (spread) elsewhere in the body beyond the organ it originated in. Few of the treatment techniques for breast cancer surgery are as follows:
Mastectomy refers to total removal of the breast owing to breast cancer. Before beginning the mastectomy procedure, an intravenous drip is connected to the patient's body for ease of passing on medication into it. An electrocardiogram machine is also attached to the patient's body for continuous monitoring of vital signs in course of the entire surgery. Subsequently anesthesia is given for making the patient lose consciousness.
The surgery duration depends on of the extent of the cancer and type of mastectomy the person is told to undergo. The type of mastectomy depends in turn on a host of factors such as stage, grade, size of tumor and whether lymph nodes have grown.
Simple or total mastectomy, subcutaneous mastectomy, modified radical mastectomy, partial and radical mastectomy are the sub-types of this procedure.
- Total Mastectomy
Total mastectomy is also referred to as simple mastectomy. It does not include excision of lymph nodes. A total mastectomy procedure entails excision of entire breast through an elliptical incision which is 6 to 8 inches in length. The incision is made starting from the inside of the breast extending in upward direction straight towards the armpit. This type is done for preventing recurrence of cancer, Paget's disease of nipples and ductal carcinoma in situ, which is a type of breast cancer. A mastectomy refers extraction of the full breast and the contents like nipple and areola. When performed on both breasts, it is termed as double mastectomy.
- Subcutaneous Mastectomy
Also known as nipple-sparing mastectomy, areola, skin and nipples in breast aren't removed, only the breast tissue affected by cancer is excised in subcutaneous mastectomy. Surgeons and oncologists do not consider this method suitable for cases wherein tumors are too large or are present under the areola and nipples. Also, this method is always used along side breast reconstruction surgeries. So that makes the breast look much better than the original breast.
- Modified Radical Mastectomy
A modified radical mastectomy is recommended when cancer has grown beyond lymph nodes. It also involves removal of nipple, areola, and surrounding breast tissues. The surgery for this initial stage of breast cancer is done in 2-4 hours. Breast reconstruction is also possible post this surgery. This surgery commences with administration of general anesthesia. Post that the surgeon makes an incision across the chest for pulling back the skin and removing breast tissue.
- Partial Mastectomy
In this method, tissues surrounding the tumor and the tumor itself are both removed. Usually it is done when the cancer is in its initial stages. It is also referred to as a quadrantectomy. A partial mastectomy is performed under anesthesia and through an incision made in the breasts around nipples. The position of nipple changes post surgery. Also breast reduction surgery can be done for adjusting breast sizes of operated breast and the healthy one too.
- Radical Mastectomy
This method also involves removal of breast tissue, lymph nodes in armpit and chest and also the nipples. A modified radical mastectomy is more effective and hence, the radical method is not in extensive use these days. A radical mastectomy is a very rarely used treatment type. It is preferred only if the person's breast cancer has advanced to a dangerous stage.
A lumpectomy is also called as breast-conserving method as it involves removal of a small portion of breast rather than the whole organ itself. When cancer is confirmed, a lumpectomy is teamed with radiation therapy to keep the cancer from returning. Discomfort experienced by the patient differs according to the site of incision and amount of tissue removed.
When abnormalities are detected in the breast, a radioactive marker is inserted on the location of the tumor before surgery. This marker acts as a guide for pointing out the exact area which needs operation. The excised tumor is then sent to a laboratory for analysis. Post that the incisions are closed with the help of dissolvable stitches. The procedure is same if sentinel lymph nodes or axillary lymph nodes need to be operated on.
The above mentioned treatment types fall in the surgical range. Chemotherapy, radiation therapy and hormone therapy are the therapeutic measures for treating breast cancer and tumors in breast. These measures are used along with the surgical methods to treat cancer.
Following listed are the recovery tips to be followed in the weeks after discharge from hospital:
- Remain active - Avoid sitting or sleeping all day long in the days post your surgery. Deep vein thrombosis is just one risk that happens if proper exercises are not done in the recovery period.
- Pain relief medication - Be sure to stock up on pain relief medications approved by your doctor. As pain relief medicines come in handy when pain during recovery days becomes unbearable.
- Heavy work - Usually, lifting heavy objects and electrical appliances during recovery period is banned for the patient.
- Drainage tubes - In some patients, drainage tubes are inserted into the armpit during surgery for accumulating blood and other fluid during initial days of recovery. The drains need to be tracked for first 2 weeks till they are fit to be taken out by doctor.
- Exercise regime - Follow the exercise regime chalked out for you by your doctor or consult a phyiotherapist. Exercising is important to reduce the numbness, burning, tingling and soreness experienced on the chest.
- Follow-up appointments - Do not forget to attend the follow-up appointments scheduled by your doctor for checking any possible health scares resulting from cancer surgery and those which can impede recovery.
- Contact the doctor if - Post surgery in the recovery period, if you notice issues, such as fever with chills, blood coming out of dressings, tension or depression, trouble in emptying your bowels, aches experienced despite consuming pain relief medication, contact the hospital immediately.
Diet Post Breast Cancer Surgery
During recovery from cancer surgery, patient should consume a very simple diet which is easy to digest. There are no specific food restrictions, but patient should avoid consuming food with high fat content, alcoholic substances and red meat specifically. Women who are habitual smokers, have to give up smoking as much as possible after surgery. Though following a healthy diet plan is not the mainstream treatment for breast cancer, it does help the patient to recover quickly post surgery.
Risks and Complications
There are few complications associated with breast cancer surgeries mentioned above.
Few risks that mastectomy carries with itself are as follows:
- Bruising – It is a common occurrence that goes away in a couple of weeks after mastectomy.
- Haematoma – Occassional bleeding in tissues that causes swelling which is painful is a possibility. Medical intervention may be required for stopping it.
- Infection due to wound - The wound after surgery can become swollen and red. It is also likely to cause discharge from the wound.
- Psychological effects – Life after getting diagnosed for breast cancer can be severely devastating in terms of routine, career and relationships. Similarly, the decision for surgery and undergoing it can be traumatic too.
- Fever - Mastectomy may make people feel feverish. Antibiotics may be prescribed for curing it.
- Fluid build-up - Fluid may build up in the site of incision done for surgery. Fluid build-up usually disperses within 3- 4 weeks.
- Reduced sensation - There is a reduced sensation in areas of skin present around breast post mastectomy.
- Heaviness felt in breasts – Post the surgery, the operated breast may feel heavy and uncomfortable for few months ahead. However, that can be alleviated by wearing a comfortable bra.
- Change in posture - After undergoing mastectomy, some women may notice a change in their posture due to removal of the breast. Using a breast prosthesis helps.
- Reaction to anesthesia
- Bleeding from breasts
- Asymmetrical breasts
Sleep disturbances, nausea, loss of body hair, bleeding etc. are few risks chemotherapy carries with itself. While, damage to heart, chances of contracting secondary cancers are few other risks that are attached with radiation therapy.
To conclude, it is important to note that the above mentioned dietary additions need to be followed throughout your life ahead for leading a healthy and disease-free life.
Treatment structure decided by oncologists and cancer specialists differs for person to person. This article was just to give you an idea about the treatment options and lifestyle changes to be made post surgery for a healthier and better life.
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