Cancer of any sort is a fearsome diagnosis. Breast cancer is none the less frightening; however, better detection tools including immuno-histochemical methods and screening methods have reduced the sting as cancers are caught earlier and therefore patients have better outcomes.
As well, gene research has uncovered the BRCA1 and BRCA2 gene mutation which has a high likelihood of a woman with such mutations developing breast cancer. Some women decide to prophylactically have their breasts removed rather than take the chance. Every year in the U.S. there are more than 350,000 cancer-related breast surgeries.
As early as 1894, two surgeons — William Halstead at John Hopkins in Baltimore, and Willy Meyer in New York City — each published landmark papers detailing the “radical mastectomy” technique in which they removed all of the patient’s breast tissue, the overlying skin, the pectoral muscles, and all of the underarm lymph nodes.
This invasive procedure left women disfigured, with permanently limited movement and in chronic pain. The surgeons, of course, were saving women’s lives; however, the women’s lives were significantly altered.
In the 1970s, it became clear to women’s doctors that cutting away large portions of women’s bodies did not increase survival, so began the breast-conserving treatments in which doctors attempt to shrink the cancer tumors using chemo, radiation and medication and then proceed with less extreme surgical procedures.
Almost all women need to face some type of surgery when diagnosed with breast cancer, either lumpectomy — which takes just the tumor and a small amount of surrounding tissue — or a full mastectomy.
For a lumpectomy, the breast-conserving choice is performed in collaboration with a pathologist who examines the excised tissue to determine if the margins (edges) are clear of cancer. The edges must be clear of cancer with a small border of healthy tissue surrounding the excised lump in order to be sure that all the cancer was removed.
Usually after the lumpectomy, the patient is given about a month to heal before starting a round of radiation therapy lasting from three to seven weeks to reduce the risk of a recurrence. The long-term physical side effects of having a lumpectomy are usually minimal; however, there are scars which may be disfiguring and which distort the shape of the breast.
Some women will decide to have breast reconstruction work using fat from another part of their body, or even an implant depending on the size of the lump. The lumpectomy is usually reserved for women who have stage I or II with a cancer that is not dispersed throughout the breast.
The total or simple mastectomy is the most common type of surgery for breast cancer, and is used when a woman has multiple or large areas of invasive cancer. It is also the procedure used for those who wish to have the breasts removed prophylactically because they have the gene mutation which elevates their risk for cancer. In this procedure the surgeon removes the entire breast, and most of the overlying skin.
A lymph node biopsy is performed to determine whether the cancer has spread to the lymphatic system. The procedure usually takes about three hours in the operating room and requires a few days hospital stay. Depending on the type of tumor some women will be advised to take follow-up treatment in the form of chemotherapy, radiation or hormone therapy.
The more extensive the surgery, the more complications may arise, such as pain, swelling, restricted arm movement, lasting numbness in the chest and upper arm, and chronic nerve pain in the chest, arm and armpit.
The modified radical mastectomy is the technique used for women who have a breast cancer that is locally advanced or inflammatory. The surgeon removes the breast, the overlying skin and the some of the lymph nodes under the arm. The full-on radical mastectomy is rarely performed these days, as patients are usually given chemotherapy or endocrine therapy to shrink the tumor so a less invasive surgery can be employed.
If a woman and her doctor decide that a mastectomy is needed, another decision that is required is whether or not to have an implant installed either immediately after the breast is removed or at a later date. The are two main shapes of implants — either round or teardrop, and some surgeons have personal preferences as to the type.
Implants can be either saline or silicone filled, and most women prefer the silicone ones because they feel more like natural breast tissue. The down side is that if a silicone implant ruptures it can be difficult to detect, whereas if a saline implant ruptures, it usually deflates within a few days.
Breast cancer treatment has evolved significantly. Monthly self-checks and annual physical exams by your health care provider can help you detect lumps in your breasts. Living clean and healthy, not smoking, avoiding alcohol and eating lots of anti-oxidant rich foods can help you avoid cancers of all sorts.
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Dr. Jane Riley, EdD., is a certified personal fitness trainer, nutritional adviser and behavior change specialist. She can be reached at janerileyfitness@gmail.com, 212-8119 cell/text, www.janerileyfitness.com
