Who Needs A Lumpectomy
You may be a candidate for a lumpectomy if:
- Cancer only affects one area of your breast.
- A tumor is relatively small compared to your breast size
- Your provider is confident you will have enough remaining tissue to reshape your breast after removing the tumor.
- You are able to complete radiation therapy.
Types Of Breast Cancer Surgery
Breast-conserving surgery : This procedure removes a tumor from the breast. A lumpectomy;differs from a mastectomy, which removes the entire breast. Women who undergo a lumpectomy are usually recommended to receive radiation therapy;following surgery to help prevent recurrence. Some women are candidates for intraoperative radiation therapy, which typically limits the amount of radiation treatments needed after surgery. Commonly referred to as breast conservation therapy, a lumpectomy when coupled with radiation therapy is designed to allow a woman to keep her breast.
Mastectomy: This is the surgical removal of all the breast tissue. If breast conservation therapy is not a viable option, mastectomy may be recommended. Women who have cancer in multiple areas of the breast and/or large tumors relative to the size of the breast are typically recommended to undergo a mastectomy. Women with certain genetic mutations may also be recommended for a mastectomy.
In many instances, much of the breast skin and even the nipple may be spared to improve the outcome of reconstruction.
There are several different types of mastectomy:
- Nipple-sparing mastectomy, where only the breast tissue is removed
- Skin-sparing mastectomy, where the breast tissue is removed with the nipple and areola
- Total mastectomy, where the breast tissue and skin are removed
- Modified radical mastectomy, where the whole breast is removed, along with the lymph nodes under the arm
When Can I Expect To Recover From Surgery
Recovery after surgery involves healing both on a physical and emotional level and the time taken varies from individual to individual.; The length of time you spend in hospital will depend on the extent of your surgery and how quickly you recover.; Going home can arouse mixed emotions.; You may feel enormous relief that the operation is over.; You may feel isolated or insecure because you no longer have the immediate support of the nurses, doctors and the hospital team. Feel free to contact our breast care nurses if you have any queries or just need some psychological support if you feel a bit down after discharge.
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Follow Up Care After Breast Cancer Treatment
Many women are relieved or excited to be finished with breast cancer treatment. But it can also be a time of worry, being concerned about the cancer coming back, or feeling lost without seeing their cancer care team as often.
For some women with advanced breast cancer, the cancer may never go away completely. These women may continue to get treatments such as chemotherapy, hormone therapy, or other treatments to help keep the breast cancer under control and to help relieve symptoms from it. Learning to live with breast cancer that doesnt go away can have its own type of uncertainty.
Even if you have completed breast cancer treatment, your doctors will want to watch you closely. Its very important to go to all of your follow-up appointments. During these visits, your doctors will ask if you are having any problems, and will probably examine you. Lab tests and imaging tests aren’t typically needed after treatment for most early stage breast cancers, but they might be done in some women to look for signs of cancer or treatment side effects.
Checking Lymph Nodes During Surgery
The sentinel node is the first node that fluid drains to from the breast into the armpit. This means its the first lymph node the cancer could spread to.
Lymph nodes that look normal on ultrasound, are checked further by your surgeon during your operation to remove the breast cancer. This is called a sentinel lymph node biopsy .;
A few hours before the operation, your doctor or a radiographer;injects a small amount of mildly radioactive liquid into your breast close to the tumour. The radioactive liquid is called a tracer.
During the operation, your surgeon might also inject a small amount of blue dye into the breast. The dye and the tracer drain away from the breast tissue into nearby lymph nodes.
The surgeon can see which group of lymph nodes the dye reaches first.;They also use a radioactive monitor to see which nodes the tracer reaches.;They usually;remove about 1 to 3 of these nodes. They send them to the laboratory to see if they contain cancer cells. The results can take about a week.
The dye can stain your breast slightly blue. It gradually fades over a few weeks or months. The dye may also turn;your urine green for a few days.
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Radiation Therapy After Lumpectomy
Radiation therapy is usually given after lumpectomy to get rid of any cancer cells that might be left in the breast. These cells are too small to see on mammograms or other imaging tests, or to measure with lab tests.
Radiation therapy can lower the risk of :
- Breast cancer recurrence
- Breast cancer death
If lumpectomy and mastectomy are both options for surgery, survival with lumpectomy plus radiation therapy is the same as with mastectomy .
The Tissue Surrounding A Tumor And What It Means For Your Treatment
Jennifer Schwartz, MD, is a board-certified surgeon and Assistant Professor of Surgery at the Yale School of Medicine.
If you require a lumpectomy for breast cancer, your surgeon will remove the tumor and a border of tissue surrounding it called the surgical margin. A pathologist will then examine the tissue to determine if all the cancer cells in that area are gone or if further treatment is needed. If cancer cells are found anywhere between the tumor itself and the outer edge of the margin, additional surgery may be recommended.
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Getting A Breast Biopsy
In a breast;biopsy, the doctor takes out small pieces of breast tissue to check them for cancer cells. A biopsy is the only way to tell for sure if you have breast cancer.
There are many types of biopsies. Ask your doctor what kind you will need. Each type has risks and benefits. The choice of which type to use depends on your own case.
Sometimes, surgery is needed to take out all or part of the lump to find out if its cancer. This is often done in a hospital using local anesthesia . You might also be given medicine to make you sleepy.
Getting Your Incision Wet
Keep your incision clean and dry for 1 week after surgery. You may need to take sponge baths rather than showers. Bathing in a bathtub is OK if you keep the incision area dry.
Small pieces of tape will remain over the incision. They usually fall off by themselves.
Donât go swimming until your doctor and surgeon say itâs OK.
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What To Expect After Breast Reconstruction Surgery
Its important to have an idea of what to expect after surgery to rebuild your breast, including the possible risks and side effects. The time it takes you to recover from surgery will depend on the type of reconstruction you have. Most women begin to feel better in a couple of weeks and can return to usual activities in a couple of months. Talk to your doctor about what you can expect. Be sure you understand how to take care of your surgery sites and how to follow up with your breast care, including regular mammograms and when they are needed depending on the surgery you have had.
What Factors Can Affect The Choice Of Breast Reconstruction Method
Several factors can influence the type of reconstructive surgery a woman chooses. These include the size and shape of the breast that is being rebuilt, the womans age and health, her history of past surgeries, surgical risk factors , the availability of autologous tissue, and the location of the tumor in the breast . Women who have had past abdominal surgery may not be candidates for an abdominally based flap reconstruction.
Each type of reconstruction has factors that a woman should think about before making a decision. Some of the more common considerations are listed below.
Reconstruction with Implants
- Enough skin and muscle must remain after mastectomy to cover the implant
- Shorter surgical procedure than for reconstruction with autologous tissue; little blood loss
- Recovery period may be shorter than with autologous reconstruction
- Many follow-up visits may be needed to inflate the expander and insert the implant
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How Do Surgeons Use Tissue From A Woman’s Own Body To Reconstruct The Breast
In autologous tissue reconstruction, a piece of tissue containing skin, fat, blood vessels, and sometimes muscle is taken from elsewhere in a womans body and used to rebuild the breast. This piece of tissue is called a flap.
Different sites in the body can provide flaps for breast reconstruction. Flaps used for breast reconstruction most often come from the abdomen or back. However, they can also be taken from the thigh or buttocks.
Depending on their source, flaps can be pedicled or free.
- With a pedicled flap, the tissue and attached blood vessels are moved together through the body to the breast area. Because the blood supply to the tissue used for reconstruction is left intact, blood vessels do not need to be reconnected once the tissue is moved.
- With free flaps, the tissue is cut free from its blood supply. It must be attached to new blood vessels in the breast area, using a technique called microsurgery. This gives the reconstructed breast a blood supply.
Abdominal and back flaps include:
Flaps taken from the thigh or buttocks are used for women who have had previous major abdominal surgery or who dont have enough abdominal tissue to reconstruct a breast. These types of flaps are free flaps. With these flaps an implant is often used as well to provide sufficient breast volume.
Wearing A Bra And Artificial Breast Shape
After breast cancer surgery, you can wear a comfortable non underwired bra. You can wear this at night to help support your breast.
If youve had a mastectomy without reconstruction, your nurse will give you a lightweight, artificial breast shape that you can wear inside your bra. It’s;very soft and will not put pressure on the wound.
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When May Mastectomy Be The Best Surgical Option
A mastectomy may be the best surgical option when:
- There are 2 or more tumors in different areas of the breast .
- The tumor is large and neoadjuvant therapy will not be given.
- The tumor has spread throughout the breast .
- The mammogram showed large areas of suspicious calcifications in the breast.
- The tumor is located just below the nipple and the cosmetic look after lumpectomy will not be good.
- The surgeon cannot get negative margins after multiple attempts by lumpectomy.
- Radiation therapy cant be given.
Learn about .
Who Its Suitable For
Letrozole is suitable for women who have been through the menopause and whose breast cancer is oestrogen receptor positive.
Sometimes letrozole is given alongside a drug called goserelin to women who havent yet been through the menopause.;
If your cancer is hormone receptor negative, then letrozole will not be of any benefit.
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How Long Will I Have To Take It
This will depend on your individual circumstances, but letrozole is usually taken for five to ten years.
Some people start taking letrozole after a few years of taking the hormone therapy drug tamoxifen.;
If youre taking letrozole to treat breast cancer that has come back or spread to another part of the body, youll usually take it for as long as its keeping the cancer under control.
Who Uses Cam Instead Of Medicine
So how would a decision to accept no treatment, or to only use alternative medicine, compare to conventional cancer care ? And what about delaying conventional cancer care to allow a trial of alternative medicine does it have a measurable effect? Answering this question isnt straightforward.; In cancer research, new drugs are typically added to, or follow, established therapies, so all patients receive standard treatment options as part of their care. So we cant ethically randomize patients to nothing, when established treatments exist. But we can answer this question in a different way: Patients that voluntarily opt out of cancer treatment can be followed, and compared to patients that do take cancer treatment. While it isnt a prospective randomization, which would be the gold standard, its the best we can get. But even this approach is difficult. Most patients who decide to opt-out of cancer treatment, also opt-out of any follow-up evaluation. So tracking down patients, and their outcomes, is essential.
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What Factors Can Affect The Timing Of Breast Reconstruction
One factor that can affect the timing of breast reconstruction is whether a woman will need radiation therapy.;Radiation therapy can sometimes cause wound healing problems or infections in reconstructed breasts, so some women may prefer to delay reconstruction until after radiation therapy is completed. However, because of improvements in surgical and radiation techniques, immediate reconstruction with an implant is usually still an option for women who will need radiation therapy. Autologous tissue breast reconstruction is usually reserved for after radiation therapy, so that the breast and chest wall tissue damaged by radiation can be replaced with healthy tissue from elsewhere in the body.
Another factor is the type of breast cancer. Women with inflammatory breast cancer usually require more extensive skin removal. This can make immediate reconstruction more challenging, so it may be recommended that reconstruction be delayed until after completion of adjuvant therapy.
Even if a woman is a candidate for immediate reconstruction, she may choose delayed reconstruction. For instance, some women prefer not to consider what type of reconstruction to have until after they have recovered from their mastectomy and subsequent adjuvant treatment. Women who delay reconstruction can use external breast prostheses, or breast forms, to give the appearance of breasts.;
Outcomes Of Breast Cancer In Patients Who Use Alternative Therapies As Primary Treatment
This was a medical chart review by Chang et al, published in the American Journal of Surgery in 2006. It examined breast cancer patients who refused conventional chemotherapy, or delay its initiation, in order to use CAM. The authors calculated each patients prognosis at the time of diagnosis. In total, 33 women were included. The results were grim:
- Eleven patients initially refused surgery. Ten of these patients experienced progressive disease. Five ultimately had surgery. In the six others, the cancer had already metastasized, so surgery would have offered no benefit.
- Three patients refused to allow sampling of lymph nodes to evaluate disease spread. One of these patients developed recurrent disease in the lymph nodes.
- Ten patients refused local control of the tumor site. Two patients developed recurrences in the same location, and two developed metastatic disease.
- Nine patients refused chemotherapy, raising their estimated 10-year mortality from 17% to 25%
Consistent with the study above, the vast majority of breast cancer patients who refuse surgical intervention developed progressive disease. Even delaying surgery increased risks and overall mortality. Outcomes were better for patients that accepted surgery, but refused adjuvant treatments, like chemotherapy. However, even this strategy significantly raised 10-year mortality estimates.
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Who Cannot Have Radiation Therapy
Not everyone can have radiation therapy. Being pregnant, having certain health conditions or having some inherited gene mutations can make radiation therapy harmful.
- Pregnancy. Radiation can harm a fetus. Depending on the timing of the pregnancy and the breast cancer diagnosis, a woman may be able to have a lumpectomy and safely wait until after delivery to have radiation therapy.
- Scleroderma. Radiation therapy can cause harm to normal tissue during and after treatment in people who have scleroderma. In some women at higher risk of breast cancer recurrence, radiation therapy may still be used.
- Some inherited gene mutations. Radiation therapy can cause harm to normal tissue during and after treatment in people who have certain inherited gene mutations. In some women at higher risk of breast cancer recurrence, radiation therapy may still be used.
- Past radiation therapy to the same breast or to the same side of the chest. In general, radiation therapy to the breast can only be given once. In rare cases, radiation therapy to the same breast or overlapping parts of the body can be considered after talking with your radiation oncologist.
How Does The Doctor Know I Have Breast Cancer
A change seen on your mammogram may be the first sign of breast cancer. Or you may have found a lump or other change in your breast.
The doctor will ask you questions about your health and will do a physical exam. A breast exam is done to look for changes in the nipples or the skin of your breasts. The doctor will also check the lymph nodes under your arm and above your collarbone. Swollen or hard lymph nodes might mean breast cancer has spread there.
Mammogram: This is an x-ray of the breast. Mammograms are mostly used to find breast cancer early. But another mammogram might be done to look more closely at the breast problem you might have.
MRI scan: MRIs use radio waves and strong magnets instead of x-rays to make detailed pictures. MRIs can be used to learn more about the size of the cancer and look for other tumors in the breast.
Breast ultrasound: For this test, a small wand is moved around on your skin. It gives off sound waves and picks up the echoes as they bounce off tissues. The echoes are made into a picture that you can see on a computer screen. Ultrasound can help the doctor see if a lump is a fluid-filled cyst , or if it’s a tumor that could be cancer.
Nipple discharge exam: If you have fluid coming from your nipple, some of it may be sent to a lab. There, it will be checked to see if there are cancer cells in it.
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