Doctors at NYU Langone’s Perlmutter Cancer Center may perform breast-conserving surgery or mastectomy when treating women with breast cancer.
Breast-conserving surgery, also called a lumpectomy or partial mastectomy, is an option for women with ductal carcinoma in situ and early invasive cancer. This surgery is usually followed by radiation therapy.
During breast-conserving surgery, our surgeons remove the cancer along with a border of healthy tissue to ensure no cancer cells remain. Our surgeons plan treatment with the goal of leaving as much of the breast intact as possible.
Doctors can evaluate the tissue margins at the time of surgery with a device called a MarginProbe. This consists of a probe that uses electromagnetic waves to examine the surface of the tumor after it is removed and a console that analyzes the probe’s measurements. This information helps doctors determine if the tissue margin contains cancer cells. If cancer cells are present, more surgery may be needed.
Our doctors use MarginProbe to identify cancer cells in the tissue margin around breast cancer tumors.
Pathologists evaluate the tumor and tissue margins. Results of the pathologist’s tests are available after the surgery is complete.
Sentinel Lymph Node Removal
Doctors also perform a sentinel lymph node removal during breast-conserving surgery for invasive breast cancer. Lymph nodes are part of the lymphatic system, which consists of organs and vessels that drain excess fluid from tissues and help the body fight infections.
Before surgery, doctors inject a radioactive tracer. During surgery, they may inject a blue dye. The tracer travels through the breast tissue to nearby lymph nodes under the arm. The first several nodes to absorb the tracer are called the sentinel nodes because if cancer spreads outside the breast, it is likely to spread to these nodes first.
Doctors can find this node or nodes using a gamma probe, a device that can detect the radioactive tracer. This helps doctors determine where to make an incision. The blue dye further helps them identify the correct node or nodes to remove during surgery.
Doctors remove the sentinel nodes through a small incision under the arm to see if they contain cancer. If they don’t, then no further lymph nodes need to be removed.
If cancer is found in the sentinel nodes, your surgeon may discuss with you whether another procedure, called axillary lymph node dissection, is needed to remove additional nodes where cancer may have spread.
Axillary Lymph Node Dissection
During an axillary lymph node dissection, doctors may remove as many as 10 to 15 lymph nodes to evaluate them for cancer. This procedure is slightly more likely than sentinel lymph node removal to cause a condition called lymphedema, a swelling under the arm due to poor lymph fluid drainage. Our doctors can help you take steps to prevent lymphedema and manage it, if it occurs.
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Mastectomy involves removing the entire breast, nipple, and areola, the ring of pigmented skin surrounding the nipple. This procedure may be recommended for women who have extensive ductal carcinoma in situ and those who have a large invasive cancer or multiple tumors.
Doctors can also perform a mastectomy when breast-conserving surgery may produce results that a woman finds cosmetically unacceptable. It is also recommended if a woman has already been treated with radiation therapy. Women who have had this treatment cannot receive additional radiation, which is typically administered after breast-conserving surgery, or lumpectomy.
During a mastectomy, doctors may perform a sentinel lymph node dissection to determine if cancer has spread to area lymph nodes. If cancer is detected in the lymph nodes, doctors perform an axillary lymph node dissection in a separate surgery to ensure that all potentially cancerous nodes are removed.
Most mastectomies can be done using skin-sparing techniques, meaning surgeons remove breast tissue but leave behind as much healthy skin as possible for women who choose to have breast reconstruction. Your breast surgeon and reconstructive surgeon discuss this option with you.
Doctors sometimes remove both breasts, depending on the risk of cancer affecting the other breast. This is called bilateral mastectomy. You and your doctors discuss whether this is the right option for you.
In some women with very small tumors or early breast cancer that is not near the nipple or areola, surgeons can perform a total skin-sparing mastectomy that leaves the nipple and areola intact. Doctors remove breast tissue as close to the nipple and areola as possible to ensure that all potentially cancerous cells are removed. Breast reconstruction is then performed at the same time as the mastectomy. Our breast in a day surgery, during which surgeons perform a nipple-sparing mastectomy and implant reconstruction on the same day, may be an option for some women.
Perlmutter Cancer Center breast oncologists and reconstructive surgeons can help you decide if this is a good option for you. Not all breast tissue can be removed during nipple-sparing mastectomy. There is always a tiny amount of breast tissue left behind. For this reason, your doctor needs to continually monitor you in the following years. Your doctor can recommend an appropriate follow-up plan for you.
Recovery from Breast Surgery
If you’ve had breast-conserving surgery, you may go home the same day. If you’ve had a mastectomy with sentinel lymph node dissection, you may only have to spend one day in the hospital. However, if you’ve had reconstructive surgery, the stay is slightly longer and depends on the type of procedure. During this time, doctors monitor you and help manage any pain.
Women who have axillary lymph node dissection may return home with a drain placed under the arm. This tube drains fluid away from the wound and may need to stay in place for several days to help reduce swelling.
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