Treatment

Surgery

Surgery to remove cancer from the breast tissue and any affected lymph nodes is the most common procedure used to treat breast cancer. Depending on your diagnosis, surgery may be only the treatment you receive, but it is usually performed in conjunction with other therapies.

The Washington University surgeons at Siteman offer a number of different surgical procedures for breast cancer. If you wish to have breast reconstruction, and your doctor thinks you are a good candidate, the reconstructive process can be started during your cancer surgery. Click here to learn more about breast reconstruction options at Siteman.

There are two major categories of breast cancer surgery: breast-conserving surgeries and mastectomies. Additionally, patient may be interested in breast reconstruction surgery.

Breast conserving surgeries

The goal of a breast-conserving surgery is to take out the cancerous tissue while leaving much of the breast intact. Many people refer to these procedures as lumpectomies, but a lumpectomy is just one type of breast-conserving surgery.

Lumpectomy

A lumpectomy is a procedure to remove the tumor (or lump) from the breast. It’s sometimes called a “partial mastectomy.” The surgeon will cut out the tumor as well as a layer of surrounding tissue to ensure that no cancer cells are left behind. Lymph nodes are often removed as well so they can be examined for signs of cancer.

Patients with stage I or stage II breast cancer or ductal carcinoma in situ are the best candidates for a lumpectomy. The tumor also has to be small in proportion to the entire breast. Some women will receive chemotherapy first to shrink the tumor to increase their chance of having breast-conserving surgery.

Some patients fear that having a lumpectomy makes it more likely that their cancer will return and choose to have a full mastectomy instead. However, there is no evidence that lumpectomies enable breast cancer to recur. Most lumpectomy patients will undergo a course of radiation after the surgery in order to make sure there are no more cancer cells in the breast.

Lumpectomy with breast reduction

 For women with large breasts, the surgical oncology and plastic surgery team can do a breast size reduction. They start on the breast with cancer, removing the lump and the cancer-free tissue that surrounds it. Then, the other breast is reduced to match.

Mastectomy

A mastectomy is a procedure to remove the entire cancerous breast. Sometimes, patients with especially aggressive cancers or other high-risk factors will choose to have both breasts removed. This procedure is called a bilateral mastectomy.

Mastectomies may be performed for patients with stage I and stage II breast cancer and are often performed for patients with stage III cancer due to the large tumor size. Even women who need mastectomies may first undergo chemotherapy to improve the surgeon’s ability to cleanly remove the cancer in the breast and the lymph nodes.

Patients with inflammatory breast cancer may become eligible for a mastectomy following chemotherapy. Because of the nature of inflammatory breast cancer, surgeons always opt to perform a mastectomy instead of breast-conserving surgery, and seldom initiate breast reconstruction during the same procedure.

Skin and Nipple-sparing Mastectomy

At Siteman, our surgeons can conduct a variation on the mastectomy known as a skin and nipple-sparing mastectomy. It preserves the nipple and as much of the skin as possible. Though the procedure is only appropriate in patients whose tumors are not too close to the nipple or whose breasts are not too large, it makes reconstruction much easier when it can be done.

The surgeons at Siteman Cancer Center have special expertise in these surgeries. They have performed more than 1,000, the largest volume in St. Louis and most of the U.S.

What is the recovery process like after breast cancer surgery?

The recovery process for breast cancer surgery can last anywhere from one week to a few months.

Breast-conserving surgery is typically done as an out-patient procedure. Patients can often return to work after two to three days and should be back to their normal schedules after about a week. If they’ve undergone a lymph node biopsy in addition to the surgery, the recovery period may last slightly longer.

Mastectomies can also be performed on an out-patient basis, but some patients may have to stay in the hospital for a day or two, especially if they’ve had both breasts removed or a reconstruction procedure as well. It can take several weeks to recover. Some patients may not feel completely back to normal for a few months.

Your care team at Siteman will be available to answer questions and provide guidance at any point in your recovery. You’ll continue to see your surgeon for follow-up appointments to make sure you are healing well.