Treating breast cancer requires team work, collaboration, and coordination. It involves several medical professionals from different disciplines, including:
Breast Surgeon or Surgical Oncologist: The breast surgeon is responsible for removing the cancerous tissue by performing a lumpectomy or mastectomy.
Plastic Surgeon (Breast Reconstruction Surgeon): The Plastic Surgeon performs breast reconstruction surgery at the same time as the lumpectomy or mastectomy.
Medical Oncologist: Only if needed, a medical oncologist will provide chemotherapy treatment.
Radiation Oncologist: Only if needed, a radiation oncologist will provide radiation treatments.
Radiologist: The radiologist uses advanced imaging technology to examine your breasts and lymph nodes so the surgical team and other members of the care team know the type, location, and extent of the breast cancer so the best treatment can be planned.
Genetic Specialist: A genetic specialist assists in determining if you are at higher risk of developing the disease due to a genetic mutation or may use laboratory tests to assess risk.
Nurse Navigator: Your nurse navigator coordinates the healthcare team involved in your treatment, facilitating coordination amongst the members of your treatment team. Your nurse navigator also helps you better understand the process and can connect you with breast cancer survivors to help you understand what to expect in the journey.
Physical Therapist: After surgery, a physical therapist may work with you to help you regain strength, activity, and range of motion.
A lumpectomy is a breast-conserving surgery that removes abnormal or cancerous tissue from the breast. Unlike a mastectomy, which removes the entire breast, a lumpectomy is designed to only remove a smaller portion of the breast. Normal tissue is also extracted around the lump to ensure that all the cancerous tissue is removed. A lumpectomy is usually performed to verify a diagnosis of cancer or to treat the early stages of cancer. Most commonly, if a woman chooses a lumpectomy, radiation therapy will be required to decrease the chances of the cancer returning.
A lumpectomy preserves a portion of the native breast. However, the radiation treatment, often required after a lumpectomy procedure, may deform the shape and appearance of the remaining breast. In addition, radiation can permanently damage the skin of the breast. It can decrease the blood supply to the skin and subsequently cause it to contract.
Women who have a history of breast radiation who later undergo a mastectomy are at a higher likelihood of having healing problems at the radiated site. In addition, women who choose to pursue a lumpectomy will have to continue breast cancer surveillance (i.e. sonograms, mammograms, MRI). Reconstructive surgery, performed at the time of the lumpectomy (preferable) or after, can help improve the aesthetic appearance of the breast treated with a lumpectomy.
A mastectomy is a surgery that removes the entire breast. A mastectomy is a treatment option for women who have breast cancer or those who do not wish to have a lumpectomy. In addition, many women who are in a high-risk group elect to have a prophylactic mastectomy, which is a preventive surgery that removes a normal breast to prevent the occurrence of breast cancer.
It is important to remember that after a mastectomy, women no longer require imaging (i.e. sonograms, mammograms, MRI), as the breast tissue has been removed. There are different types of mastectomy surgeries, and your surgeon will consult with you about your options.
With a nipple-sparing mastectomy, a woman’s existing, natural nipple and areola are preserved. The obvious advantage is the aesthetic benefit, as no further surgery is required to reconstruct the nipple-areola complex. A common misconception is that leaving the nipple-areola complex increases the chance of cancer recurrence, but this is false. Research reveals, in the appropriately selected patient, there is no increase in cancer recurrence in patients who have had nipple-sparing mastectomy compared to patients who have undergone a traditional mastectomy.
There are some limitations to a nipple-sparing mastectomy, the first of which is that not all women are candidates. It may not be the right surgical option for large cancers or those occurring near the nipple. Since all the ducts terminate at the nipple, the nipple is considered part of the breast and therefore is usually removed when the cancer is it near that structure. Women with very large or ptotic (sagging) breasts may not be ideal candidates. When considering this treatment, you should be aware that there may be a loss of sensation or altered appearance of the nipple areola complex.
A skin-sparing mastectomy is a technique to save the breast skin while removing all the underlying breast tissue and nipple. The preserved skin structure provides a good shape and form for implant or flap (autologous) reconstruction. This type of mastectomy is one of the more favorable options due to the natural look, feel, and aesthetic results in immediate breast reconstruction – performed in the same surgery as the mastectomy.
Choosing to have a mastectomy can be a very emotional and difficult decision for many women. For women considering mastectomy of a breast affected by cancer, the question often comes up as to what should be done with the other breast. You may elect to have one breast (unilateral mastectomy) or both breasts removed (bilateral mastectomy). Some women with breast cancer in one breast will choose to have the opposite healthy breast removed in what is called a “contralateral prophylactic mastectomy” (CPM).
© Neil Tanna MD. All rights reserved.