Surgical options for breast cancer include lumpectomy or mastectomy, with or without evaluation of the axillary (armpit) lymph nodes. In general, the ten-year survival rate is considered the same for both procedures.
Memorial Sloan-Kettering surgeons have been leaders in the development of national guidelines for the use of a breast-conserving treatment called lumpectomy (also called a wide local excision, segmental resection, or partial mastectomy). In this procedure, only the cancerous breast tissue, with a rim of normal tissue around it, is removed.
Lumpectomy is performed as an outpatient surgical procedure, and is often combined with sentinel node biopsy. Most women do not require the use of drains after the operation. Lumpectomy also preserves sensation in the breast, an important consideration for many women.
Whether or not a woman can undergo a lumpectomy depends on the size of her tumor, the size of her breast, the number of sites of cancer within the breast, and whether she can undergo subsequent radiation treatments, among other factors. Between 70 and 90 percent of women with newly diagnosed, early-stage breast cancer are medically appropriate candidates for lumpectomy. For women whose cancers are too large for a lumpectomy to be performed without causing significant changes in the appearance of the breast, chemotherapy is sometimes used to shrink the cancer before lumpectomy. Our surgeons, breast-imaging specialists, and radiation oncologists work together to ensure optimal outcomes for women who choose this treatment.
Patients who choose lumpectomy usually receive radiation therapy to the breast area after surgery.
With mastectomy, the entire breast (usually including the nipple) is removed. The muscle on the chest wall (pectoral muscle) is not removed, although if cancer is very close to the muscle, a small piece of muscle underneath the cancer may be taken. Depending on the stage of the breast cancer, some women are advised to undergo radiation therapy after mastectomy.
A patient who undergoes a mastectomy must decide whether she wants the breast to be reconstructed, and which type of reconstruction will work best for her. Breast reconstruction can be performed safely either during the mastectomy, or as a second procedure at any time following a mastectomy (even years later).
Memorial Sloan-Kettering surgeons offer innovative reconstructive techniques for women who have undergone a mastectomy. A major advance in breast reconstruction, called skin-sparing mastectomy, may be appropriate for some patients. In this procedure, the surgeon removes the inner breast tissue and nipple, leaving a shell of skin in place. He or she then fills in the shell with tissue from the woman's abdomen or places a tissue expander underneath the chest (pectoral) muscle and, later, reconstructs the nipple. This approach results in a more natural-looking breast.
For almost all women, the reconstructed nipple won't have any sensation, and significant numbness in the remaining skin of the breast is likely. For a select group of patients with small cancers not located near the nipple, the nipple and areola may also be preserved. There will still be sensory changes and the nipple will not become erect or function like a normal nipple, but this approach can provide excellent cosmetic results.
Lymph Node Biopsy
Planning drug treatment for breast cancer requires that doctors determine if it has spread to the lymph nodes. In the past, they had no choice but to remove most of the underarm lymph nodes — an operation called axillary dissection. At Memorial Sloan-Kettering, we now offer a conservative surgical procedure for many women that is easier to tolerate, speeds recovery time, and enables them to return sooner to their normal day-to-day activities.
During lumpectomy or mastectomy, Memorial Sloan-Kettering's surgeons routinely perform what is called a sentinel node biopsy. We remove one or more lymph nodes under the arm, and a pathologist then looks at them closely to see if the breast cancer has spread. Sentinel lymph node biopsy saves many patients from the most troublesome potential side effect of more extensive surgery — lymphedema, or swelling of the arm.
If the sentinel lymph node(s) are free of cancer, the remaining axillary lymph nodes are left alone. If the sentinel lymph node(s) contain breast cancer cells, removal of the remaining axillary nodes (axillary dissection) is necessary for patients undergoing mastectomy. Newer research indicates that for women with only a few sentinel nodes containing cancer and who are having treatment with lumpectomy and radiotherapy, axillary dissection offers no benefit. Our breast surgeons at Memorial have developed specific guidelines to include these new findings in our clinical practice.