State of the Art Approach
Our breast cancer surgeons take pride in discussing the surgery options with each patient and providing excellent specialized care.
- Oncoplastic Techniques
- Nipple sparing mastectomy
- Prophylactic mastectomy
- Sentinel lymph node Biopsy
- Breast Reconstruction- Implants, DIEP flap
Breast Cancer Surgery Options
Since most breast cancers are detected early, lumpectomy is often a safe option. During a lumpectomy, the breast is preserved and the surgeon removes the cancer with additional surrounding normal breast tissue. This is an outpatient procedure that can be performed with intravenous sedation and usually requires only 2-3 days off work. It may require placement of a guidewire by the radiologists before going to the operating room for the lumpectomy.
For large breast cancers, multiple cancers in the same breast, or with patient preference, mastectomy may be the safest option. Mastectomy means removing the entire breast and the nipple/areolar complex with general anesthesia. Breast reconstruction by a plastic surgeon can be performed at the time of the mastectomy with either tissue expanders, implants, or using your own abdominal tissue (DIEP flap or TRAM flap). The hospital stay is based on the type of reconstruction and is usually between 1 to 4 nights. The nipple/areolar complex is reconstructed as an outpatient several months later.
Nipple sparing mastectomy is a newer type of mastectomy performed in selected patients that does not remove the nipple/areolar complex. The nipple does not have sensation after this mastectomy; however it may provide a more natural looking reconstruction.
Oncoplastic Breast Surgery
In select patients with a moderate size breast cancer, a larger lumpectomy (or quadrentectomy) may be combined with a reconstructive surgery such as a reduction/lift in order to preserve the breast. This oftentimes requires a reduction/lift on the other breast for symmetry.
Sentinel Lymph Node Biopsy
Sibley was among the first breast health centers in the nation to practice sentinel lymph node biopsy. This procedure, performed at the time of the breast cancer surgery, removes the first lymph nodes from under the arm that drain the breast (usually 1-3 lymph nodes). While in the operating room, a pathologist will examine these lymph nodes to determine if breast cancer cells have spread to the axilla. These sentinel lymph nodes are identified by injecting a small dose of radioactivity in the breast before surgery and blue dye during surgery. If no cancer metastasis is found in the sentinel lymph node, the patient can be safely spared from having all of the axillary lymph nodes removed and its higher chance of complications including lymphedema.
Axillary Lymph Node Dissection
An axillary lymph node dissection removes all of the lymph nodes under the arm. It is performed when a sentinel lymph node biopsy or axillary lymph node fine needle aspiration shows metastasis or in advanced breast cancer cases. A drain is usually placed in the axilla for 7 to 10 days to prevent a fluid collection.
Breast Cancer Reconstruction Options
Plastic surgeons with an interest in breast reconstruction team are active participants in the Sibley breast cancer multidisciplinary team. Reconstruction options have greatly improved over the past decade, providing women with satisfying results. Our plastic surgeons discuss with each patient her specific expectations and concerns in order to achieve the best result.
The least invasive option is placing a temporary implant called a tissue expander underneath the pectoralis muscle at the time of surgery. The expander is inflated with saline over several office appointments to reach the desired size. It is exchanged to the final implant, saline or silicone, about a month after expansion is completed.
In select patients, permanent implants may be placed at the time of mastectomy. There now exists a wide range of saline and silicone implants based on the patient and her plastic surgeon’s preference.
For patients desiring to use their own body’s tissue for breast reconstruction, the DIEP (deep inferior epigastric perforator) flap or TRAM (transverse rectus abdominus myocutaneous) flap are the most common options. These surgeries remove the skin and fat tissue from the abdomen thereby providing a "tummy tuck" and build a new breast mound. The TRAM flap is more invasive, removing the abdominal muscle and fascia.