Surgery is a local treatment for breast cancer. It may be used to remove cancer tumors from the body, determine the extent of cancer spread, and possibly reconstruct the breast.
There are different surgical options available to patients. Surgery may remove all (mastectomy) or part (lumpectomy) of the breast tissue. It may also remove—or spare—the nipple, areola and skin.
The extent of surgery required is determined by several factors including tumor type (DCIS, IDC, ILC, etc.), tumor size, and whether cancer has spread to the lymph nodes. The patient’s personal preference is also considered. In some cases and for various reasons, this results in removal of the second, non-cancerous breast (prophylactic mastectomy).
Reconstructive surgery, if desired, may follow at a later time or be done in conjunction with tumor removal surgery. See more regarding reconstruction options here.
Good general information about breast cancer surgery can be found here.
Personal Experience
I chose to have a bilateral mastectomy with breast implant reconstruction. The decision to have a bilateral mastectomy was made based on several factors:
- Size of the primary tumor
- extensive calcification surrounding the primary tumor
- positive lymph node biopsy (cancer was on the move!)
- contralateral breast “scare”—a breast MRI showed suspicious lymph node size on second breast. A later fine needle aspiration biopsy showed everything was fine.
Medical Surgeon Consultation
In the last month of chemotherapy, I met with my medical surgeon to finalize surgery details. I had not seen her since my initial diagnosis. When we discussed bilateral mastectomy, she made sure I understood that there is no proven survival benefit connected to removing the second unaffected breast. I was also informed that surgical risk is higher because of an extra surgical site and extended surgery time/anesthesia. After careful thought and research, I reaffirmed my choice to have a bilateral mastectomy. I didn’t want any breast tissue left in my body to worry over. Even though surgery doesn’t get every last bit—there is a very small chance that residual breast tissue or cancer cells could recur on the chest wall)—it was close enough for my piece of mind!
At the same surgeon consult, we talked about
- skin and nipple sparing options
- incision placement (across nipple line or under breast fold)
- axillary lymph node dissection.
A lymph node biopsy—done at diagnosis—had shown the breast cancer had invaded my lymphatic system through at least one lymph node under my armpit. I chose to have sentinel lymph node (SLN) surgery rather than a more extensive axillary node dissection (ALND). If the sentinel nodes came back positive for residual cancer, I agreed to a complete axillary node dissection at that point. I was offered participation in a research study, Alliance A11202, if I preferred to avoid ALND even with residual nodal disease. Consistent with my choice of a bilateral mastectomy, I’d rather risk extended node dissection side effects—lymphedema—than leave any residual cancer in my body. I declined the study.
Take a Break
Surgery was scheduled approximately 4 weeks after my final chemotherapy infusion.
While my body rested between chemotherapy and surgery, I had a post-chemo mammogram, ultrasound and breast MRI. These tests were done to see what my cancer looked like after chemotherapy.
As I awaited that magical surgery date, I also met with my plastic surgeon to discuss breast implants. We agreed that it made sense to tag-team with my medical surgeon and place tissue expanders at the time of mastectomy. Implant exchange—final implants replacing tissue expanders—would happen at least 3 months later. If I chose to have radiation, implant exchange would be delayed longer.
Day Before Surgery
The day before surgery, I had a procedure called a lymphoscintigraphy. This was to identify my sentinel lymph nodes and highlight the previously cancer positive lymph node, clipped at initial biopsy. No matter which nodes lit up as sentinels, the cancer positive node would be removed. Although not horrible, the pain during the radioactive seed placement—4 seeds in each breast—wasn’t much fun.
Surgery Day
The morning of surgery, I arrived at the hospital (Mayo Clinic Rochester) at 5:45a for a surgery time of 9a. My bleary-eyed family—husband, boys, parents—was there with me. I changed into a gown, had my vitals taken and got an IV in my arm. The hospital chaplain stopped by the family room and said a short prayer with us. This was by request, a service offered by the hospital. Then hugs and kisses with the family before I was wheeled away to the pre-op holding area. My parents lived in town—we did not—so the family shuttled back and forth between the hospital and G&G (“grandma and grandpa”) home base.
When I got to the pre-op holding area, I was visited first visited by my medical surgeon and then my plastic surgeon, separately. They drew on me with markers, answered last minute questions and generally made me feel comfortable with the upcoming surgery. My general surgeon also said a prayer with me. (I knew she would, her PA told me in previous appointments that she did it often). The anesthesiologist also stopped by to introduce himself and ask/answer questions. By the time all this happened, a nurse had given me medication to relax and it was time to go!
Operating Room
I remember being wheeled into the brightly lit operating room and seeing many bodies working. I don’t know how many people were part of my medical team but I felt very popular. My surgeon smiled and said everything was ready. My anesthesiologist put an oxygen mask over my face. He told me to breathe deeply as he gave me some “pure oxygen”. Ha! There was more than oxygen in that mask because I don’t remember anything else before waking up in the recovery room. Surgery was supposed to start at 9a. I woke up in recovery at around 3p.
Recovery
I was kept in the recovery area for about an hour. When I first woke up to the multitude of beeps and buzzes of hospital monitoring equipment, I was very groggy and disoriented. A team of medical personnel were monitoring several patients, separated by curtains, as we recovered from the effects of anesthesia. No nausea—a common effect of anesthesia—for me, thank goodness. Just slow consciousness and discomfort in my chest area. I didn’t have sharp pain, just a heaviness. Once the nurses were satisfied with my recovery, I was wheeled to my hospital room. I would be spending at least 1 night in the hospital.
Overnight Stay
When I got to my hospital room, my husband was there to greet me. I don’t remember much because I was still pretty out of it. He says I was “loopy” when I first arrived:). By the time my parents brought the boys from G&G home base—about 30 minutes—I was talking and aware. I remember being uncomfortable but not in pain. I was bound up tight across my chest and had two JP drains.