the different types of surgery
There are two types of surgery for breast cancer:
Breast-conserving surgery, also known as lumpectomy
And the removal of the breast, known as a mastectomy.
Depending on the situation, surgery on the axillary lymph nodes may be performed in addition to the operation.
Lumpectomy or breast-conserving surgery
The goal of breast-conserving surgery is to remove the entire tumor without removing the entire breast.
The tumor is removed with a safety margin—that is, an area of healthy tissue surrounding the malignant lesion—to ensure that no malignant cells remain in the breast.
This safety margin thus reduces the risk of recurrence.
The nipple and areola are preserved, unless the tumor is located directly beneath them.
Breast-conserving surgery is very often combined with a sentinel lymph node biopsy and followed by adjuvant radiation therapy to the operated breast.
When analysis of the tumor and surrounding tissue shows that the safety margin is insufficient, the surgeon may recommend a second surgical procedure.
It can also happen that, following a lumpectomy, the final results show that the tumor was not completely removed, which may lead the surgeon to recommend a mastectomy.
Conversely, when the tumor is too large to allow for a lumpectomy, the doctor may recommend chemotherapy before any other treatment to reduce the tumor’s size and make breast-conserving surgery a possibility at a later stage.
This is referred to as neoadjuvant chemotherapy.
Similarly, if the woman has gone through menopause, hormone therapy is sometimes recommended before surgery.
Mastectomy, or breast removal
A total mastectomy involves removing the entire breast, including the areola and nipple.
Depending on the medical situation, breast reconstruction may be recommended, either at the same time (known as immediate reconstruction) or at a later date.
If breast reconstruction is postponed, the patient may wear an external breast prosthesis in the meantime.
Surgery on the axillary lymph nodes
When breast cancer is diagnosed, it is often essential to determine whether or not the axillary lymph nodes contain cancer cells, and thus to assess the extent of the disease.
The axillary lymph nodes are then analyzed using the sentinel lymph node technique.
The results are used to determine the choice of treatment.
In particular, it helps determine whether lymph node removal—known as axillary lymph node dissection—is necessary to prevent the disease from progressing.
The Sentinel Lymph Node Technique
The sentinel lymph node is the first lymph node to receive lymphatic drainage from a tumor.
It is representative of the other lymph nodes in the armpit and therefore helps determine whether axillary lymph node dissection is necessary.
A lymph node is said to be «positive» when it contains cancer cells; it is «negative» when it does not.
The advantage of the sentinel lymph node technique is that it avoids the inconvenient consequences of routine axillary lymph node dissection, which proves unnecessary when the removed lymph nodes are negative.
To ensure that the sentinel lymph node can be easily located by the surgeon during the operation, a physician from the Nuclear Medicine Department injects a radioactive substance (called a tracer) near the tumor or close to the areola a few hours before the procedure.
This product enters the lymphatic system and accumulates in the first axillary lymph nodes.
A scintigraphy performed at that time allows for their precise localization and thus makes it easier for the surgeon to remove them.
Axillary lymph node dissection
If cancer cells have been detected in the axillary lymph nodes, an axillary lymph node dissection is performed.
This involves removing about ten lymph nodes located under the arm.
It is performed at the same time as breast-conserving surgery or a mastectomy.
If lymph node involvement is not detected until after the final analysis of the sentinel lymph node, axillary lymph node dissection may be performed at a later stage.
