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Breast Cancer Treatments Including Mastectomy

lymph node removal, mastectomy, breast reconstruction

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There can be more than one approach to breast cancer treatment. The multidisciplinary team mentioned above has a round table discussion for the best outcome specific to each patient who is positively diagnosed with breast cancer. This is a huge advantage to the patient so they are not having to jog to several consultations, and potentially getting discordant information at each visit. The panel can collectively put a care plan together and the navigator will take that directive and escort these women through their course of care.

Below, we've listed some of the considerations discussed for care options. Click on any option below to learn more.

Breast Conservation Surgery

For most women, breast conservation will be the cancer treatment of choice since it is less traumatic, and the survival results are identical to survival rates with complete breast removal. However, not all women are candidates for breast conservation, and some women prefer mastectomy. We believe women should be given the facts and encouraged to make their own choices.

Women considering breast conservation must have a clear understanding of the issue of '”margins". The goal in breast conservation is to remove the tumor, along with a surrounding rim of normal tissue. Obtaining clear margins all around the tumor edges can be a challenge.

Although the surgeon attempts to take out the entire tumor at the time of the initial surgery, in some cases the tumor cells (which are not visible during the surgery) are found by the pathologist to extend to the edge (margin) of the lumpectomy specimen, and a second operation is required. Fortunately, the vast majority of women who initially choose breast conservation will ultimately achieve a good to excellent cosmetic result. Long-term survival is equal to that with breast removal surgery.

Mastectomy

Some women are either not candidates for breast conservation or choose mastectomy for personal reasons. Women considering this procedure should be given the option of immediate reconstruction. Some women, however, are not good candidates for immediate reconstruction because of an underlying medical condition, such as diabetes. For these women there is still the option of delayed reconstruction, and this option should be taken into consideration at the time of the initial mastectomy.

Reconstructive Surgery

Reconstructive Surgery can help repair the part of the body that is affected from a number of issues. For example, a woman who has undergone breast removal surgery, or a child born with a birth defect such as a cleft lip or palate. Or perhaps you've experienced a traumatic injury or disease that has permanently affected some part of your body that you want fixed.

At Saint Alphonsus, our Plastic and Reconstructive Surgeon offers a number of different types of reconstructive surgeries that can help improve the problem, whatever it may be.

Linsey Etherington, MD Linsey Etherington, MD, is a Plastic and Reconstructive Surgeon who has completed advanced training in the latest plastic surgery techniques. This highly skilled surgeon provides leading edge expertise in plastic and reconstructive surgery, offering a wide range of services including:

Breast surgery and breast reconstruction
Facial reconstruction
Trunk and extremity reconstruction
Wound healing
Flap surgery

Immediate or Delayed Breast Reconstruction
Breast reconstruction can help restore the look and feel of the breast after removal. For many women this is a very important option. At Saint Alphonsus Women's Specialty Care Center, Dr. Etherington offers immediate breast reconstruction (a procedure done at the same time as breast removal surgery) or delayed reconstruction (done at a later date). The timing depends on your situation and the treatment you will have after surgery. If you are interested in this option you will need to discuss your options with both Dr. Etherington, your breast surgeon, and your oncologist in advance.

Breast Reduction Surgery
Also known as reduction mammoplasty, breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body and to alleviate the discomfort associated with overly large breasts. Most women who get breast reduction are very satisfied with the results. Men with conditions such as gynecomastia (in which male breasts are abnormally enlarged) may also get breast reduction.

Trunk and Extremity Reconstruction
This procedure is performed to reconstruct an area of the chest wall, to cover a defect of the abdomen created by injury or surgical resection, or to reconstruct complex pressure wounds. Reconstructive techniques and strategies vary greatly depending on whether we are covering spinal implants for neurosurgery patients or restoring the ability to walk to a trauma victim.

Wound Care
For individuals who have been severely burned or cut, skin grafts or other reconstructive techniques are available.

Flap Surgery
Flap reconstruction surgery is a procedure that involves moving healthy, live tissue from one location of the body to another, often to areas that have lost skin, fat, muscle movement, and/or skeletal support. Flap surgery can be used for procedures such as breast reconstruction or trunk and extremity reconstruction. It may also be used to augment facial/nasal reconstruction.

For more information, or to schedule an appointment with Dr. Etherington, call 208-302-2200.

Chemotherapy Before Surgery

Giving chemotherapy first (neoadjuvant therapy) is becoming a more common option for cancer treatment before surgery. In the past, chemotherapy was given before surgery in situations where the tumor was too large to permit removal.

The chemotherapy was given first to shrink the tumor so that a mastectomy could be successfully performed. It is now becoming common practice to give chemotherapy first to shrink the tumors so that less tissue is taken at the time of the lumpectomy, which leads to improved cosmetic results. We have had extensive experience with this approach and have now saved hundreds of breasts that in the past would have required surgery.

Radiation Therapy

A 6-8 week course of irradiation therapy will be recommended for women undergoing lumpectomy (radiation therapy may be safely avoided in selected women with small, non-invasive cancers). The purpose of radiation is to eliminate any remaining cancer cells in the breast following lumpectomy, and it is very effective in lowering the rate of cancer recurrence in the breast (see Link to Radiation Therapy).

There is now an alternative to standard radiation therapy which can be accomplished in just 5 days (see link to What's New…new technology… partial breast irradiation).

Radiation is painless and takes only a few minutes to perform. It is much like a simple chest x-ray in that a beam of energy goes through the breast without the patient being aware that anything is happening. With breast irradiation, the energy beam is much stronger than the energy for a chest x-ray. The most common side effect of breast irradiation is redness to the skin. There is no hair loss or nausea with breast irradiation as there is with chemotherapy.

Lymph Nodes and Sentinel Node Biopsy

Lymph node removal will be recommended for most women with breast cancer. Lymph nodes are Lymph node removal will be recommended for most women with breast cancer. Lymph nodes are lima bean shaped structures that vary in size from that of a pea to the size of a marble. A primary function of a lymph node is to filter unwanted materials from the body, and this includes cancer cells. In fact, if breast cancer cells break off from the main tumor, the first place they are likely to go is to the lymph nodes under the arm (i.e. the axillary lymph nodes). One of the most important indicators of prognosis is the status of the axillary lymph nodes (i.e. no nodes involved good means prognosis; the more nodes involved, the worse the prognosis).

For this reason, it was standard cancer treatment in the past to remove all of the lymph nodes under the arm at the time of the removal of the breast cancer to determine prognosis. It is now standard practice to remove only the first draining lymph node (sentinel lymph node) at this time of the lumpectomy or mastectomy, and have it examined under the microscope (see link to sentinel lymph node). If the lymph node is free of cancer cells, no other lymph nodes are removed. By limiting the number of nodes removed, recovery is accelerated and the risk of complications (such as lymphedema) are minimized (see link to Lymphedema ).