the different types of surgery
There are two types of breast cancer surgery:
Conservative surgery, known as lumpectomy
And the removal of the breast, called a mastectomy.
Depending on the situation, a procedure on the axillary lymph nodes completes the operation.
Lumpectomy or conservative surgery
Conservative surgery aims to remove the entire tumor without removing the entire breast.
The tumor is removed with a safety margin, i.e. a zone of healthy tissue around the malignant lesion, to ensure that no malignant cells remain in the breast.
This safety margin limits the risk of recidivism.
The nipple and areola are preserved, except when the tumor is located just below them.
Conservative surgery is very often combined with sentinel lymph node examination, followed by additional radiotherapy on the operated breast.
When analysis of the tumour and surrounding tissue shows that the safety margin is insufficient, the surgeon may propose a second operation.
It can also happen that after a lumpectomy, the final results reveal that the tumor has not been completely excised, which may lead the surgeon to propose a mastectomy.
Conversely, when the tumor is too large to allow lumpectomy, the physician may propose chemotherapy before any other treatment to reduce the size of the tumor and allow conservative surgery to be considered at a later stage.
This is known as neoadjuvant chemotherapy.
Similarly, if the woman is menopausal, hormone therapy is sometimes recommended before surgery.
Mastectomy or removal of the breast
Total mastectomy involves removing the entire breast, including the areola and nipple.
Depending on the medical situation, breast reconstruction is offered, either simultaneously (immediate reconstruction) or as a second stage.
If breast reconstruction is deferred, the patient can wear an external breast prosthesis in the meantime.
Axillary lymph node surgery
Once breast cancer has been diagnosed, it is often essential to check whether or not the axillary lymph nodes contain cancer cells, and thus to measure the extent of the disease.
The axillary lymph nodes are then analyzed using the sentinel node technique.
The result is used to determine the choice of treatments.
In particular, it is used to determine whether lymph node removal, known as axillary lymph node curage, is necessary to prevent the development of the disease.
The sentinel 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 can therefore be used to determine whether or not axillary curage is necessary.
A lymph node is said to be «positive» when it is affected by cancer cells, and «negative» when it is not.
The advantage of the sentinel lymph node technique is that it avoids the inconvenient consequences of systematic axillary lymph node dissection, which proves unnecessary when the lymph nodes sampled are negative.
So that the sentinel lymph node can be easily located by the surgeon during the operation, the Nuclear Medicine Service physician injects a radioactive product (called a tracer) in the vicinity of the tumour or near the areola of the breast a few hours before the operation.
This product passes through the lymphatic system to concentrate in the first axillary lymph nodes.
A scintigraphy performed at this time helps to pinpoint their location, thus facilitating their removal by the surgeon.
Axillary lymph node dissection
If cancer cells have been detected in the axillary lymph nodes, 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 conservative surgery or mastectomy.
If lymph node involvement is only detected after definitive analysis of the sentinel lymph node, axillary dissection may be carried out at a later stage.
