Breast cancer surgery

A sentinel biopsy is a surgical procedure used to see whether cancer cells have spread to the lymph nodes. Lymph nodes are found throughout the body. If breast cancer cells break away from where they started, the sentinel nodes are the first few lymph nodes to which cancer can spread. In sentinel node biopsy, a tracer material is used to help the surgeon find the sentinel nodes during surgery. The sentinel nodes are removed and tested in a lab. If they’re free of cancer, then the cancer probably hasn't spread. This means that removing additional lymph nodes is generally not necessary.

A breast-conserving lumpectomy removes cancer while leaving as much normal breast as possible. Usually, some surrounding healthy tissue and lymph nodes also are removed. This breast-conserving surgery is sometimes called lumpectomy or partial depending on how much tissue is removed. Usually performed as an outpatient surgery, the surgeon will remove all the cancer, plus some surrounding normal tissue. This can sometimes be difficult depending on where the cancer is in the breast. The pathologist will examine the tissue that was removed and if no invasive cancer cells are found at any of the edges of the removed tissue, it is said to have negative or clear margins. Having a positive margin means that some cancer cells may still be in the breast after surgery, so the surgeon often needs to go back and remove more tissue.

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. Reconstructive surgery may be desired to have the size of the unaffected breast reduced to make the breasts more symmetrical (even). An oncoplastic lumpectomy improves a breast’s appearance after the breast cancer is removed by reshaping the breast. This could include rearranging nearby breast tissue to improve dents, divots, scars, or even nipple distortion, placing the scar where it is less visible, and reducing or lifting one or both breasts.

In this procedure, most of the skin over the breast is left in place. Only the breast tissue, nipple, and areola are removed. The amount of breast tissue removed is the same as with a simple mastectomy. Implants or tissue from other parts of the body can be used during the surgery to reconstruct the breast. Skin-sparing mastectomy has the advantage of less scar tissue and a reconstructed breast that seems more natural. But it may not be suitable for larger tumors or those that are close to the surface of the skin.

In this procedure, the breast tissue is removed, and the breast skin is saved and the nipple and areola are left in place. The surgeon may remove breast tissue under the nipple and areola during the procedure to check for cancer cells. If cancer is found in this tissue, the nipple and areola must be removed. This can be followed by breast reconstruction. This type of mastectomy is more often an option for women who have a small, early-stage cancer, away (more than 2cm) from the nipple and areola, with no signs of cancer in the skin or the nipple and who have small to medium sized breasts.

This procedure allows for a smaller incision permitting the surgeons to treat the cancer and remove the tumor while still preserving as much of the breast’s natural shape as possible. More than that, this hidden scar process offers better cosmetic results by hiding the scars in the body’s natural folds. With a Hidden Scar procedure, your surgeon will place the incision in a location that is hard to see, so that the scar is not visible when your incision heals. As a result, you have little to no visible reminder of the surgery. It is best suited for non-invasive cancers.

In this procedure, the surgeon removes the entire breast or both breasts, including the nipple, areola, and fascia (covering) of the main chest muscle, as well as the skin. A few underarm lymph nodes might be removed as part of a sentinel lymph node biopsy depending on the situation.

A double mastectomy is sometimes done as a risk-reducing or preventive surgery for women at very high risk for getting breast cancer, such as those with a BRCA gene mutation. In some cases, a mastectomy can be nipple-sparing as well.

Breast reconstruction can be done at the same time as the mastectomy or delayed (later date). Our surgeons use advanced techniques to help rebuild or replace breast tissue while restoring the natural shape and appearance of the breast as much as possible. This includes all the latest technologies involving microsurgery and tissue perfusion assessment (SPY). Techniques and recommendations will vary depending on the type of tumor, the age and health of the patient, and overall goals to restore the most normal breast. Specialized surgical oncologists, microsurgeons, and plastic surgeons work together and tailor the reconstruction based on each patient’s unique needs and expectations. Your surgical team will discuss options with you and make appropriate recommendations.

Direct-to-Implant (DTI) reconstruction uses a dermal sling (acellular dermal matrix) and involves the immediate insertion of a permanent prosthesis or implant at the time of the mastectomy. Implant reconstruction is the least invasive breast reconstruction procedure. The benefits are quicker recovery and less surgeries. This approach is often suitable for patients who have adequate skin quality and thickness to support the implant. However, with a single mastectomy, the shape of the reconstructed breast with an implant may not match the look or feel (to the touch) of the natural, opposite breast.

Natural tissue flaps are soft tissues (such as skin, fat and muscle from your own body’s donor site) that can be used to help create a reconstructed breast. Reconstruction using skin and tissue flaps tends to mimic the look and feel (to the touch) of a natural breast better than reconstruction with implants. However, natural tissue flap procedures are more invasive and complex so they usually require a longer hospital stay and a longer recovery time.

A deep inferior epigastric perforator (DIEP) flap is an all-natural reconstruction using fatty tissue from the lower abdomen to reconstruct the breast. It keeps the abdominal muscle intact which may preserve abdominal strength after the procedure and reduces the risk of abdominal site complications. It’s more complex, takes longer than some other natural flap techniques due to microvascular procedures, and leaves a large scar across the lower abdomen.

Tissue expander-based reconstruction involves the insertion of an implant which is gradually filled with saline over several months to gradually create the breast mound. It is a temporary breast implant with a small valve that can be filled over time with liquid or air. It’s placed under the chest skin or muscle after a mastectomy. A tissue expander may be the best option if you’ve decided you want breast reconstruction but either can’t, or don’t want to, have it right away.