Types of Surgery header

Mastectomy � Mastectomy involves removal of the entire breast, including the nipple.  This can be performed with immediate, delayed, or no reconstruction.

Partial Mastectomy � The term partial mastectomy is synonymous with the term lumpectomy.

Modified Radical Mastectomy � A modified radical mastectomy is similar to the simple mastectomy, but the lymph nodes in the armpit are removed along with the breast specimen.  Currently, our first step in performing a modified radical mastectomy is to remove the sentinel lymph node under the arm to determine if the cancer has spread.  If the lymph node shows cancer, we remove the breast and 20 to 30 lymph nodes under the arm.

Radical Mastectomy � A radical mastectomy includes removal of the entire breast, plus the removal of underlying chest wall muscles (pectoralis major, pectoralis minor), along with removal of the axillary lymph nodes.  This was a standard operative procedure until approximately 30 years ago. It is rarely performed today.

Lumpectomy � This treatment option is especially appropriate and successful with small, non-invasive cancers.  Thus, our primary objective in treating breast cancer patients is to save the breast whenever possible.

Lumpectomy involves the removal of the tumor with a wide margin of normal tissue.  To accomplish this in one step, careful pretreatment planning is essential with careful review of the mammogram and the underlying pathology.  The lumpectomy specimen must be meticulously removed and oriented by the surgeon.  The surface must be carefully color coded with special dyes by the pathologist so the status of the margins (i.e., the distance between the tumor and the edge of the specimen) can be accurately established.  If the margin can be adequately cleared, the breast can be saved.  Most patients will then undergo a course of radiation therapy.

Sentinel Node Lymph Node Mapping
� A technique has been developed to pinpoint the lymph nodes most likely to be involved with cancer cells.  This technique is called Sentinel Lymph Node Mapping.  It is defined as the first lymph node(s) to which a cancerous tumor would drain.

Sentinel Lymph Node Mapping always involves injection of a blue dye around the tumor just before surgery is performed.  Often, a radioactive material (technetium) will also be injected in the breast by a radiologist a few hours prior to surgery.

Both the blue dye and the radioactive material travel to the lymph nodes.  These specific nodes, �blue� to the naked eye of the surgeon and or �hot� form the radioactive material when using a hand held Geiger counter, will be sampled.

If these nodes show cancer cells, then a routine axillary dissection will be performed.  A drain will be place for several days.  If the nodes are negative, then usually no other nodes are removed.


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