Why Choose Moffitt For Breast Cancer Surgery
At Moffitt, we take a comprehensive, multispecialty approach to breast cancer treatment. Our experienced breast cancer surgeons offer a full range of surgical options using the most innovative and cutting-edge techniques. In addition, a full range of clinical treatments and supportive care is available all in one convenient location. As a National Cancer Institute-designated Comprehensive Cancer Center, Moffitt is recognized for its ongoing research efforts in addition to its world-class clinical treatment. Our robust clinical trials program gives patients access to the most groundbreaking treatment options before theyre widely available.
Medically reviewed by Nazanin Khakpour, MD, FACS, surgical oncologist, Breast Oncology Program.
Which Type Of Surgery Will I Have
The type of surgery recommended for you depends on the type and size of the cancer, where it is in the breast and whether more than one area of the breast is affected. It will also depend on the size of your breast.
Your specialist team will explain why they think a particular operation is best for you.
You may also have some or all of the lymph nodes removed with the breast tissue.
Find out more about the .
Chronic Pain After Breast Surgery
Some patients have problems with nerve pain in the chest wall, armpit, and/or arm after surgery that doesnt go away over time. This is called post-mastectomy pain syndrome because it was first described in women who had mastectomies, but it occurs after breast-conserving therapy, as well.
PMPS is thought to be linked to damage done to the nerves in the armpit and chest during surgery. But the causes are not known. Between 20% and 30% of women develop symptoms of PMPS after surgery. It isnt clear how common this is in men after breast cancer surgery. It seems to be more common in younger patients, those who had a full ALND , and those who were treated with radiation after surgery. Because ALNDs are done less often now, PMPS is less common than it once was.
Symptoms of PMPS include:
- Pain and tingling in the chest wall, armpit, and/or arm
- Pain in the shoulder or surgical scar
- A “pins and needles” sensation
- Severe itching
Most patients with PMPS say that their symptoms are not severe, but PMPS can cause you to not use your arm the way you should, and over time you could lose the ability to use it normally. Tell your doctor if you are having pain or other symptoms of PMPS. Nerve pain requires different treatment from other types of pain. See Cancer Pain for more information.
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Breast Cancer: Types Of Treatment
Have questions about breast cancer? Ask here.
ON THIS PAGE: You will learn about the different types of treatments doctors use for people with breast cancer. Use the menu to see other pages.
This section explains the types of treatments that are the standard of care for early-stage and locally advanced breast cancer. Standard of care means the best treatments known. When making treatment plan decisions, you are strongly encouraged to consider clinical trials as an option. A clinical trial is a research study that tests a new approach to treatment. Doctors want to learn whether the new treatment is safe, effective, and possibly better than the standard treatment. Clinical trials can test a new drug and how often it should be given, a new combination of standard treatments, or new doses of standard drugs or other treatments. Some clinical trials also test giving less treatment than what is usually done as the standard of care. Clinical trials are an option to consider for treatment and care for all stages of cancer. Your doctor can help you consider all your treatment options. Learn more about clinical trials in the About Clinical Trials and Latest Research sections of this guide.
How Do Surgeons Reconstruct The Nipple And Areola
After the chest heals from reconstruction surgery and the position of the breast mound on the chest wall has had time to stabilize, a surgeon can reconstruct the nipple and areola. Usually, the new nipple is created by cutting and moving small pieces of skin from the reconstructed breast to the nipple site and shaping them into a new nipple. A few months after nipple reconstruction, the surgeon can re-create the areola. This is usually done using tattoo ink. However, in some cases, skin grafts may be taken from the groin or abdomen and attached to the breast to create an areola at the time of the nipple reconstruction .
Some women who do not have surgical nipple reconstruction may consider getting a realistic picture of a nipple created on the reconstructed breast from a tattoo artist who specializes in 3-D nipple tattooing.
A mastectomy that preserves a woman’s own nipple and areola, called nipple-sparing mastectomy, may be an option for some women, depending on the size and location of the breast cancer and the shape and size of the breasts .
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Going Into Hospital And Pre
Going into hospital may be a new experience for you and you might feel anxious, particularly if youre not sure what to expect. The following information might help you to prepare.
You might also find it helpful to download our booklet Your operation and recovery, which has more information about your admission to hospital, during your stay and your recovery at home.
Think About What Is Important To You
After you have talked with a breast cancer surgeon and learned the facts, you may also want to talk with your spouse or partner, family, friends, or other women who have had breast cancer surgery.
Surgery Choices: Theresa, Cindy, Paula
Three women describe how they decided which type of breast cancer surgery was right for them.
Then, think about what is important to you. Thinking about these questions and talking them over with others might help:
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How Long Will I Be In The Hospital
The length of your stay in the hospital will vary, depending on the type of surgery you have, how well you tolerate the operation, and your general health.
Lumpectomies are usually outpatient procedures. Youâll recover in a short-stay observation unit and will likely go home later the same day.
If you have a mastectomy or an ALND, youâll probably stay in the hospital for 1 or 2 nights.
Sentinel Lymph Node Biopsy
In an axillary sentinel lymph node, the surgeon removes the first lymph nodes under the arm to which breast cancer cells may spread from the primary tumor location.
- Helps to evaluate the extent of disease and assists the oncologist in determining whether chemotherapy or radiation therapy is required
- Helps the surgeon determine whether an axillary lymph node dissection is needed
- May potentially avoid unnecessary removal of lymph nodes in the axilla, helping to reduce both the length of surgery and the risk of developing lymphedema, a condition in which fluids builds up in the extremities
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Specialists And Board Certification
Specialists are doctors who have trained in a specific area of medicine. After finishing the training for their specialty, they must pass an exam given by the specialty board. Doctors who pass the national board exams become board-certified specialists. Doctors who have not completed the specialty board exam are “board-eligible” but are not specialists.
Board certification is a sign that a doctor is highly trained in their field. Several fields related to cancer care have national boards that set standards that doctors must meet in order to be certified.
But some of the specialties that are important in cancer treatment donât have board certifications. Doctors who practice in these specialties are board-certified in a broader field. For example, there is no board certification for breast cancer surgery. Surgeons performing breast cancer surgery should be board-certified in general surgery, which gives them the basic skills to perform breast surgery.
If doctors practice in specialties that do not have national boards, additional training such as fellowships and years of experience are usually good measures of their qualifications.
Some specialists can subspecialize by completing more training in a particular area. They can sometimes become board-certified in the subspecialty, too.
Surgical Procedures Used For Breast Cancer Treatment
Common breast cancer surgeries include mastectomies and lumpectomies, although nipple-sparing and minimally-invasive procedures are also options. Other breast cancer surgery options include:
- Lumpectomy A type of breast-conserving surgery, which entails removing a tumor in a breast and a small amount of normal tissue around it.
- Mastectomy Surgery to remove part or all of the breast tissue. Different types of mastectomy vary in the amount of tissue and lymph nodes removed, including:
- Total Surgery to remove the entire breast. Some of the lymph nodes under the arm may also be removed.
- Bilateral Affecting both the right and left sides of the body.
- Prophylactic Preventative surgery to reduce the risk of developing breast cancer by removing one or both breasts before disease develops.
- Partial A type of breast-conserving surgery to remove the part of the breast that has cancer and some of the normal tissue around it. The lining over the chest muscles below the cancer and some of the lymph nodes under the arm may also be removed.
- Skin-sparing This technique preserves as much of the breast skin as possible.
- Nipple/areolar sparing The nipple and/or areola are preserved in place while the breast tissue underneath is removed.
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What To Expect On The Day
You will usually be admitted to the hospital on the morning of your operation or occasionally the day before. Theres a brief explanation below of what will happen on the day of your surgery for more detailed information, see our booklet Your operation and recovery.
A doctor from the surgical team will talk to you about your operation and discuss what has been planned. If youve not already signed a consent form, youll be asked for your written consent. This confirms that you understand the benefits and risks of your surgery, and what you are agreeing to. If youre unsure, dont be afraid to ask the doctor to explain further.
Your anaesthetist will also usually visit you on the ward before your surgery. If youre feeling anxious and would like some medication to relax you before the operation, you can ask the anaesthetist.
Once all the pre-surgery checks have been done, youll be taken to the anaesthetic room where the theatre staff will confirm your name, any allergies and when you last ate and drank. Youll be given a combination of drugs into a vein .
Youll usually be asked to take deep breaths and as the anaesthetic takes effect you will fall into a deep sleep. Once you are fully anaesthetised you will be taken into the theatre.
For more information about going into hospital, see our booklet Your operation and recovery.
Is Lumpectomy Plus Radiation Right For You
Your doctor can help you choose the best surgery for your situation. Lumpectomy plus radiation therapy may be right for you if:
you’ve been diagnosed with early-stage breast cancer
you have one tumor that is relatively small compared to the size of your breast
you prefer to keep as much of your natural breast tissue as possible
you want to avoid mastectomy and reconstruction, which is a more involved process
youre able to commit to daily radiation treatments over a period of weeks
youre pregnant, which makes radiation therapy unsafe
you cant commit to the daily schedule of radiation therapy, or distance from the nearest treatment center makes it impossible for you
there are factors that put you at higher-than-average risk for a future breast cancer, such as a strong family history or a confirmed genetic mutation associated with breast cancer risk
your surgeon has already made multiple attempts to remove the breast cancer with lumpectomy, but has not been able to completely remove the cancer and obtain clear margins
you believe you would have greater peace of mind with a mastectomy even though research shows that lumpectomy plus radiation is just as effective as mastectomy for most women, some decide that they would feel better having the entire breast removed to avoid the anxiety of future breast cancer screenings
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Breast Reconstruction Surgery After Mastectomy
After having a mastectomy a woman might want to consider having the breast mound rebuilt to restore the breast’s appearance. This is called breast reconstruction. Although each case is different, most mastectomy patients can have reconstruction. Reconstruction can be done at the same time as the mastectomy or sometime later.
If you are thinking about having reconstructive surgery, its a good idea to discuss it with your surgeon and a plastic surgeon before your mastectomy. This allows the surgical teams to plan the treatment thats best for you, even if you wait and have the reconstructive surgery later. Insurance companies typically cover breast reconstruction, but you should check with your insurance company so you know what is covered.
Some women choose not to have reconstructive surgery. Wearing a breast prosthesis is an option for women who want to have the shape of a breast under their clothes without having surgery. Some women are also comfortable with just going flat.
Using The Npi For Patient Management
Following primary breast cancer surgery, stratification of patients into different prognostic groups may assist the clinician in selecting which patients should receive systemic adjuvant therapy, either chemotherapy or adjuvant hormonal therapy. Adjuvant chemotherapy is not indicated in patients in an EPG or GPG according to the NPI because the survival advantage is small and outweighed by the risk of potentially life-threatening toxicities. In contrast, however, patients in a MPG or PPG may benefit significantly from anthracycline-based adjuvant polychemotherapy , particularly if the primary invasive carcinoma is hormone receptor negative.
With respect to carcinomas rich in estrogen receptor or progesterone receptor , the survival advantage gained from five years of adjuvant hormonal therapy is minimal for patients in the EPG or GPG relative to those women with cancers that place their predicted outcome in the MPG or PPG, who will obtain significant benefit. In addition, patients in the EPG or GPG may be unnecessarily exposed to hormonal drug side-effects or their complications which argues against recommending any post-operative hormonal treatment to such patients.
T. Chai, … D. Koyyalagunta, in, 2014
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Wire Localization To Guide Surgery
Sometimes, if the cancer in your breast cant be felt, is hard to find, and/or is difficult to get to, the surgeon might use a mammogram or ultrasound to guide a wire to the right spot. This is called wire localization or needle localization. If a mammogram is used you may hear the term stereotactic wire localization. Rarely, an MRI might be used if using the mammogram or ultrasound is not successful.
After medicine is injected into your breast to numb the area, a mammogram or ultrasound is used to guide a thin hollow needle to the abnormal area. Once the tip of the needle is in the right spot, a thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place. The needle is then taken out. Once in the operating room, the surgeon uses the wire as a guide to find the part of the breast to be removed.
The surgery done as part of the wire localization may be enough to count as breast-conserving surgery if all of the cancer is taken out and the margins are negative. If cancer cells are found at or near the edge of the removed tissue , more surgery may be needed.
It should be noted that a wire-localization procedure is sometimes used to perform a surgical biopsy of a suspicious area in the breast to find out if it is cancer or not.
There are other ways a surgeon can be guided to the tumor, but these techniques are newer and not used in every facility.
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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Breast Reconstruction Surgery After Breast
Before your surgery, talk to your breast surgeon about how breast-conserving surgery might change the look of your breast. The larger the portion of breast removed, the more likely it is that you will see a change in the shape of the breast afterward. If your breasts look very different after surgery, it may be possible to have some type of reconstructive surgery or to have the size of the unaffected breast reduced to make the breasts more symmetrical . It may even be possible to have this done during the initial surgery. It’s very important to talk with your doctor before the cancer surgery to get an idea of how your breasts are likely to look afterward, and to learn about your options.