Who Can Have Breast
Breast-conserving surgery is a good option for many women with early-stage cancers. The main advantage is that a woman keeps most of her breast. However, most women will also need radiation therapy, given by a radiation oncologist . Women who have their entire breast removed for early-stage cancers are less likely to need radiation, but they may be referred to a radiation oncologistfor evaluation because each patients cancer is unique.
- Are concerned about losing a breast
- Are willing to have radiation therapy and are able to get to the appointments .
- Have not already had that breast treated with radiation therapy or BCS
- Have only one area of cancer in the breast, or multiple areas in one quadrant that are close enough to be removed together without changing the look of the breast too much
- Have a tumor smaller than 5 cm , that is also small relative to the size of the breast
- Are not pregnant or, if pregnant, will not need radiation therapy immediately
- Do not have a gene mutation such as a BRCA or ATM mutation, which might increase your chance of a second breast cancer
- Do not have certain serious connective tissue diseases such as scleroderma or Sjögren’s syndrome, which may make you very sensitive to the side effects of radiation therapy
- Do not have inflammatory breast cancer
- Do not have positive margins
In The Months After Mastectomy
Your body will continue to adjust to the effects of the surgery over a period of months. Here are some things to keep in mind:
- You may have phantom sensations or phantom pain in the months after mastectomy: As nerves regrow, you may feel a weird crawly sensation, you may itch, you may be very sensitive to touch, and you may feel pressure. Your discomfort may go away by itself, or it may persist but you adapt to it. Analgesics and NSAIDs such as acetaminophen and ibuprofen usually can address the pain related to this type of nerve injury. Opioids also can be used to treat this type of pain. Read more about managing phantom pain.
- Continue doing regular arm exercises: Stay with your arm exercise routine to keep your arm limber.
- You may experience fatigue from time to time in the early months after surgery: If youre having trouble with fatigue, ask your doctor about things you can do.
What Happens During Lumpectomy Surgery
The lumpectomy surgery itself should take about 15-40 minutes.
Your surgeon will probably operate with a kind of electric scalpel that uses heat to minimize bleeding . Most surgeons use curved incisions that follow the natural curve of your breast and allow for better healing. If the tumor can be seen or felt, the surgeon will remove it along with a rim of healthy tissue around it.
Sometimes, but not always, a rubber tube called a drain will be surgically inserted into your breast area or armpit to collect excess fluid that can accumulate in the space where the tumor was. The drain is connected to a plastic bulb that creates suction to help remove fluid. Finally, your surgeon will stitch the incision closed and dress the wound.
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Q How Long Does It Take For Swelling To Go Down And For The New Breast To Reach Its Final Size And Shape
A. Each person is different, and much of the recovery process depends on the type of procedure performed. That said, it usually takes about three to six months for swelling to subside and for your breast to achieve a final shape, but it may take longer, particularly for patients who received radiation therapy for breast cancer treatment. Radiation permanently damages tissue at the microscopic level, which makes it harder for tissue to heal.
Also, keep in mind that final breast shape is often affected by gravity and tissue elasticity.
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Breast Cancer Cell Growth
Cancer begins when there are genetic changes, called mutations, in a normal breast cell. These changes happen in genes that control the growth of the cell. These changes may occur over a long period of time, even decades, before a cancer cell forms.
These tumor cells multiply and divide exponentially, meaning that one cell becomes two, two cells become four, and so on. That’s why a tumor size will increase more rapidly, the larger it becomes.
That said, not all cells are dividing at the same time. The cancer’s growth can change at different stages as a tumor forms. Compared with many types of cancer, breast cancer has a “low growth fraction.” This means that the proportion of cancer cells that are in an active cell cycle is low.
Some tumors, such as lymphomas and some leukemias, have much higher growth fractions. They may be active for a much shorter period of time before they are detected, even in children.
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How Do Surgeons Use Implants To Reconstruct A Woman’s Breast
Implants are inserted underneath the skin or chest muscle following the mastectomy.
Implants are usually placed as part of a two-stage procedure.
- In the first stage, the surgeon places a device, called a tissue expander, under the skin that is left after the mastectomy or under the chest muscle . The expander is slowly filled with saline during periodic visits to the doctor after surgery.
- In the second stage, after the chest tissue has relaxed and healed enough, the expander is removed and replaced with an implant. The chest tissue is usually ready for the implant 2 to 6 months after mastectomy.
In some cases, the implant can be placed in the breast during the same surgery as the mastectomythat is, a tissue expander is not used to prepare for the implant .
Surgeons are increasingly using material called acellular dermal matrix as a kind of scaffold or sling to support tissue expanders and implants. Acellular dermal matrix is a kind of mesh that is made from donated human or pig skin that has been sterilized and processed to remove all cells to eliminate the risks of rejection and infection.
Including The Study Results In Patient Counseling
Results from the new study should be incorporated into patient counseling, wrote Monica Morrow, M.D., a breast surgeon at Memorial Sloan Kettering Cancer Center, in an accompanying editorial.
The lower quality-of-life scores after mastectomy compared with breast-conserving therapy should be included in discussions about the merits of mastectomy versus breast-conserving therapy, Dr. Morrow added.
She pointed out that women with early-stage breast cancer have a low risk of developing cancer in the other breast. This information should be conveyed to patients along with the lack of survival benefit and higher risk of surgical complications with mastectomy, she wrote.
A surgeons recommendation against contralateral prophylactic mastectomy is a powerful deterrent against the use of the procedure, she wrote.
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Types Of Mastectomy The Following Types Of Mastectomy May Be Offered
A total mastectomy, or simple mastectomy, removes all of the breast and the tissue that covers the chest muscles . The lymph nodes, nerves and muscles in the chest are left in place. The nipple may or may not be removed.
If you plan to have a breast reconstruction, your doctors may try to do a skin-sparing mastectomy when they remove the cancer. A skin-sparing mastectomy is like a total mastectomy except that the surgeon doesnât remove the skin that covers the breast. This approach means that breast reconstruction can be done with very little scarring that can be seen.
Modified radical mastectomy
A modified radical mastectomy removes all of the breast, the nipple, most or all of the lymph nodes in the armpit and the tissue that covers the chest muscles . Nerves and muscles are usually left in place.
This type of mastectomy is used for breast cancer that has spread to lymph nodes. It is also used to treat inflammatory breast cancer.
A radical mastectomy is an operation that removes more muscle, lymph nodes and other tissues than a modified radical mastectomy. It is now very rarely used to treat breast cancer.
Chronic Pain After Mastectomy
Some individuals may develop chronic pain following a mastectomy. A 2018 observational study estimated that 20 to 30 percent of people who undergo breast surgery experience some type of chronic pain.
Chronic pain after mastectomy happens due to nerve damage. Its most often felt in the areas of the chest wall, armpit, or arm.
In addition to general pain or discomfort, its possible to feel:
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Take Advantage Of Patient Navigators
Though intuition would tell us that people who are insured would experience shorter delays before surgery, that doesn’t appear to be true. A large 2019 study in PLoS One looked at over 1.3 million people to see how time to initial treatment affected survival. In this study, they found that with early stage breast cancer, waiting more than 35 days between diagnosis and surgery reduced survival rates. Surprisingly, uninsured people had faster times to initiation of treatment.
While the reasons weren’t certain, it was thought that perhaps those who were insured lost precious time going through prior authorization procedures for diagnostic tests and treatment. Difficulty navigating the maze of large treatment centers may also be at play, and the authors made mention of recent clinical trials showing patient navigation could have a beneficial effect on assuring timely cancer care.
Treatment Of Local Recurrence After Previous Mastectomy
Most commonly the lesion is removed surgically and followed by radiation to the chest wall if the woman has not previously had radiation Treatment of local recurrence after mastectomy can involve a variety of different approaches, including surgery to remove the recurrence if it is confined to a limited area. Other options for treatment include radiation, chemotherapy, and endocrine therapy, or a combination of these.
Despite aggressive local treatment, many women with an isolated local recurrence following mastectomy eventually develop distant metastases. This is not because the local recurrence spreads, but rather because it is a sign that things have changed and dormant cells in other organs may also be waking up.
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When To Call The Surgeon
When you go home from the hospital after surgery, call your surgeon if you have:
- Swelling in your arm or hand, near the incision or under your arm .
- A fever over 101 degrees Fahrenheit
- Increased drainage from the surgical drain
- Increased pain not controlled with the pain medication
- Other physical problems such as loss of appetite, changes in menstrual periods, or blurred vision. It is important to also report dizziness, shortness of breath, coughing or hoarseness, headaches, or digestive problems that seem unusual or that dont go away
Last reviewed by a Cleveland Clinic medical professional on 10/22/2015.
Survival Happens Every Day
These rough estimates for how long breast cancer takes to treat can be helpful to plan your life around treatment. More importantly, they provide a light at the end of the tunnel for you to focus on. However, for your daily sanity, it may be better to break down your treatment into smaller parts. Take it from one day to the next. Remember, every day you make it, youre already winning. These factors all affect how long breast cancer takes to treat.
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Studies On Time To Surgery And Survival
Several studies have been done, but there are some differences in how these were conducted that can affect the results. For example, some studies have looked at the time between a definitive diagnosis and surgery, and others have looked at the time between the onset of symptoms and the time of surgery. Some have looked at averages of all people, whereas others have separated out people based on age, tumor type, and receptor status. Studies can also be skewed, as doctors may recommend surgery sooner for women who have more aggressive tumors. Let’s look at time to surgery and survival rates in different groups of people.
Do I Need Additional Treatment After A Lumpectomy
Cancer doctors typically recommend that women under 70 who opt for a lumpectomy also receive radiation therapy to the affected breast. This is to kill any stray breast cancer cells that remain after surgery and to prevent the cancer from coming back. This approach, also known as breast conservation therapy, has been show to be equally as effective at treating early-stage breast cancer as mastectomy.
MSKs radiation therapy teams are highly experienced in caring for women with breast cancer. We are one of just a few centers with a dedicated and specialized radiation team focused solely on treating breast cancer.
Many women also benefit from drug therapies such as chemotherapy, targeted therapy, or hormone therapy. The goal of all of these treatments is to reduce the risk of breast cancer recurring or metastasizing .
Your doctors recommendations for drug therapy are based on the molecular characteristics of your breast cancer.
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Factors Associated With More Rapid Spread
Some types of breast cancer, as well as their subtypes, are more likely to spread than other types. For example, ductal carcinoma is more likely to spread than lobular carcinoma, among tumors that are the same size and stage.
Many breast cancers do not spread to lymph nodes until the tumor is at least 2 cm to 3 cm in diameter. Some types may spread very early, even when a tumor is less than 1 cm in size.
Breast And Nipple Reconstruction
A person can choose to have surgery to reconstruct the breast and nipples. If a person does not want to undergo breast reconstruction surgery, they can use prosthetics or opt for no surgery at all. It is important to discuss these options with a healthcare professional.
According to Breastcancer.org , there are two techniques to reconstruct the breast implant reconstruction and autologous reconstruction.
An implant reconstruction is when a surgeon inserts an implant that contains saline or silicone gel. An autologous reconstruction uses tissue from other parts of the body.
A person can choose to undergo breast reconstruction at the same time as the mastectomy. However, they can also opt for delayed breast reconstruction. This might be an option if a person requires additional treatment after surgery, such as radiation therapy or chemotherapy.
If a person has undergone a lumpectomy or partial mastectomy, a surgeon may recommend oncoplastic surgery. This can help to reshape the breast and may include:
- smaller implants
for the following breast cancer surgeries are:
- Lumpectomy: Most people can get back to day-to-day activities within 510 days.
- Mastectomy: People may feel back to themselves 34 weeks after surgery.
- Mastectomy with reconstruction: This procedure has the longest recovery time, and takes up to 68 weeks.
There are side effects with all surgeries, and breast cancer surgery is no different.
The following side effects of these are:
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What You Should Know Before Having Breast
- How much of the breast is removed depends on the size and location of the tumor, your breast size, and other factors.
- Breast-conserving surgery allows a woman to keep most of her breast, but makes it likely she will also need radiation.
- After BCS, most women will have radiation therapy. Some women might also get other treatments, such as hormone therapy or chemotherapy.
- Choosing BCS plus radiation over mastectomy does not affect a womans chances of long-term survival.
- If you think you want breast reconstruction, talk to your doctor before your breast cancer surgery.
- Not all women with breast cancer can have BCS. Talk to your doctor to find out whether BCS is an option for you.
- Side effects of BCS may include pain, a scar and/or dimple where the tumor was removed, a firm or hard surgical scar, and sometimes lymphedema, a type of swelling, in the arm.
How Long Will I Stay In The Hospital After Breast Cancer Surgery
The length of stay in the hospital depends on the type of surgery and reconstruction that is performed. Generally, lumpectomies are done on an outpatient basis, and the patient recovers in a 23-hour, short-stay observation unit after the procedure.
Mastectomies with lymph node removal usually require a one- to two-night stay in the hospital with tissue flap breast reconstruction, the stay may be 4-7 days.
Most women can resume driving 10 to 14 days after surgery. Please ask your surgeon for specific recommendations.
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When Will I Get My Results
Your assessment may be done in a one-stop clinic. This is where all tests are carried out during your visit to the clinic.
Some test results may be available later that day, but if you have a core biopsy this will take longer. In some areas, you may be asked to make another appointment to finish your tests or to get your results. If this happens, you may have to wait about a week for your test results.
Possible Side Effects Of Breast
As with all operations, bleeding and infection at the surgery site are possible. Other side effects of breast-conserving surgery can include:
- Pain or tenderness or a “tugging” sensation in the breast
- Temporary swelling of the breast
- Hard scar tissue and/or a dimple that forms at the surgical site
- Swelling of the breast from a collection of fluid that might need to be drained
- Change in the shape of the breast
- Neuropathic pain in the chest wall, armpit, and/or arm that doesnt go away over time. This can also happen in mastectomy patients and is called post-mastectomy pain syndrome or PMPS.
- If axillary lymph nodes are also removed, other side effects such as lymphedema may occur.
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