I am having breast surgery. How can I prepare?

A lumpectomy involves removing the tumor along with a small portion of surrounding healthy tissue while preserving most of the breast. The appearance of the breast post-surgery varies based on the size of the tissue excised and the tumor's position. This procedure is often referred to as breast-conserving surgery.

Following a lumpectomy, radiation therapy is typically administered to the breast and occasionally to the underarm area to eliminate any remaining cancer cells that may not have been removed during the operation.

Side effects and what to expect after surgery

• Numbness around the surgical scar
• Discomfort in your chest, underarm, and shoulder areas.

A mastectomy involves the complete removal of the breast. Sometimes, radiation therapy is administered following the procedure.

• Total (simple) mastectomy: The surgeon removes the entire breast along with the chest muscle lining, leaving other tissues intact.
• Modified radical mastectomy: The surgeon removes the whole breast, the chest muscle lining, and the lymph nodes in the armpit area.

Skin-sparing mastectomy and nipple-sparing mastectomy

If you are undergoing breast reconstruction alongside a mastectomy, your surgeon might utilize either a skin-sparing or a nipple-sparing approach. A skin-sparing mastectomy aims to retain as much breast skin as possible, which can then be utilized in the reconstruction of the breast. On the other hand, a nipple-sparing mastectomy not only preserves the skin but also maintains the nipple and areola, the darker area surrounding the nipple.

Side effects and what to expect after surgery

• Numbness can extend across your chest, from the collarbone to the upper rib cage, and this sensation may persist. You may also feel soreness in the same regions.
• If axillary lymph nodes are removed, numbness could occur in your arm as well.
• There is a possibility of developing lymphedema, which is the accumulation of fluid in the arm or other areas like the hand, fingers, chest, or back, leading to swelling.

It's important to discuss any other potential side effects with your doctor. Aim to return to your usual activities as soon as you are able and with your doctor's approval.

To determine if cancer has spread to the axillary lymph nodes, many individuals undergo a sentinel lymph node biopsy during breast surgery. In this process, a radioactive tracer and/or a blue dye is injected into the breast either before or during the surgery.

The axillary lymph nodes that first take up the tracer or dye are known as sentinel lymph nodes, which are the initial sites where breast cancer is likely to spread.

The surgeon identifies these sentinel lymph nodes by detecting those that have absorbed the tracer with a gamma probe or by observing the blue color from the dye.

Typically, this method highlights 1 to 5 nodes as sentinel lymph nodes. The surgeon then removes these nodes and sends them to a pathologist for examination.

It's important to note that the removal of sentinel lymph nodes does not necessarily indicate the presence of cancer; it simply means that a pathologist will evaluate them for any signs of cancer.

Findings from a sentinel lymph node biopsy

Lymph node status indicates if breast cancer has spread to the axillary lymph nodes.

• Lymph node-negative indicates that none of the sentinel lymph nodes have cancer, suggesting that it is improbable for other lymph nodes to be affected. Therefore, additional surgery to remove more lymph nodes is not necessary.
• Lymph node-positive means that at least one sentinel lymph node has cancer present. In this case, a procedure known as axillary lymph node dissection may be performed to remove more lymph nodes. The purpose of this procedure is to determine how many lymph nodes are cancerous and to lower the risk of cancer recurring in the lymph nodes.
  
  

Axillary lymph node dissection is a more extensive procedure that involves the removal of a greater number of lymph nodes compared to sentinel node biopsy.

Women who have one or two positive sentinel lymph nodes and undergo a lumpectomy followed by whole breast radiation therapy may not require an axillary lymph node dissection. (This type of radiation targets part of the underarm area and the breast.)

Most individuals with one or more positive sentinel lymph nodes who opt for a mastectomy will likely need either an axillary lymph node dissection or radiation therapy directed at the axillary lymph nodes.

If you have a positive sentinel lymph node, it is important to discuss with your healthcare team whether an axillary lymph node dissection is necessary for your situation.