Mastectomy is the medical term for the surgical removal of one or both breasts, partially or completely. Mastectomy is usually done to treat breast cancer; in some cases, women and some men believed to be at high risk of breast cancer have the operation prophylactically, that is, to prevent cancer rather than treat it. It is also the medical procedure carried out to remove breast cancer tissue in males.
Lumpectomy is a common surgical procedure designed to remove a discrete lump, usually a malignant tumor or breast cancer, from an affected woman's or man's breast. As the tissue removed is usually limited and the procedure relatively non-invasive, compared to a mastectomy, a lumpectomy is considered a viable means of "breast conservation" or "breast preservation" surgery with all the attendant physical and emotional advantages of such an approach.
According to the National Comprehensive Cancer Network guidelines, lumpectomy may be performed for ductal carcinoma in situ (DCIS), for invasive ductal carcinoma, or for other conditions.
This surgery is primary aimed at evaluating the extent and the spread of invasive breast cancer. During any other lumpectomy or mastectomy of the invasive breast cancer, lymph nodes from the under the arm are usually removed. These are examined to assess the extent of cancer as cancer cells in the lymph nodes are indicative of the increased risk of cancer spreading to other parts of the body.
The function of the lymph nodes is to act as filter for the lymphatic drainage system of the body. Thus any cancer cells which are floating in the fluids around the cancerous tissue in the breast my get caught in the lymph nodes. Thus the lymph nodes become infected with cancer cells and swell. Supraclavicular, infraclaviculr and cervical nodes which are present around the neck and the color bone and also axillary lymph nodes present under the arms are manually checked for swellings. These enlarged nodes can be felt manually and subsequently the axillary nodes can be removed surgically. This removal of axillary lymph nodes is termed as axillary lymph node dissection.
This surgical technique is one of the most talked about recent advancements in breast cancer. This is a collateral or an alternative to axillary lymph node removal and is much less invasive in procedure. Though everyone is not suited to undergo this surgery. It has been seen that that even after undergoing sentinel lymph node surgery, patient may need to more surgical interventions for breast cancer. This surgery has its own benefits and disadvantages and must be undertaken after much thought only by the hands of an experienced surgeon.
The literal meaning of the word "sentinel" is a guard, similarly the first node or the node nearest to the fluid which is filtering away the lymphatic drainage is removed in this surgery. Naturally if the cancer is invasive and metastatic, this node would invariably be infected and can be successfully used to evaluate the spread of cancer cells.
Thus this is a less invasive procedure as instead of removal of ten or more lymph nodes only one or in reality a couple of lymph nodes are removed from the tissue. The technique is specially beneficial to women who have been diagnosed with smaller cancerous growths in the breast and who have normal looking and feeling lymph nodes post surgery. It was seen historically that over a span of 5 years women with sentinel lymph node dissection as compared to more lymph nodes removal, were as free of cancer and alive as the others.
Once the patient is aware that she is scheduled for mastectomy, the next default discussion is on breast reconstruction. There are various options available to rebuild the breast or the breasts in the surgical procedure called breast reconstruction. This procedure is undertaken during or after mastectomy or after lumpectomy. In this procedure basically, with the use of an implant a breast shape is created with the help of tissue from another part of the body.
It is worrisome and quite discomforting for women to give away a part of her body. The anxiousness and the sadness is natural, but now the woman has the chance to decide what happens later. But there are a few basic questions to which the patient must know the answer. If she is ready for another surgery on breast tissue after mastectomy or lumpectomy. If she really needs a breast reconstruction surgery to feel complete again. If she is ok with a breast form that can be taken off and put on.
It is imperative that the patient is made aware of the breast form having no sensation and breast reconstruction surgery would only reshape or reform the breast structure.
For reconstruction of breast there are two main techniques described below. It is the patient’s choice whether to have the nipple reconstructed or not.
This surgical procedure is primarily aimed at reduction in the occurrence risk of breast cancer. It in one or both of the breasts may be removed for prevention of breast cancer . in risk women this procedure has proven upto 90% reduction in breast cancer development risk.
In this surgery, ovaries and the fallopian tubes are removed. The ovaries produce eggs in the female body and also secrete the hormones estrogen and progesterone. These ovaries are connected to the uterus by the fallopian tubes.
For high risk women, women who have been detected with abnormal BRCA1 or BRCA2 genes this is a preventive measure to reduce breast cancer occurrence risk. Also for women with a family history of ovarian cancer or breast cancer this is a good solution.
This prophylactic removal is undertaken to prevent:
For breast cancer prevention in high risk women, it has proved to reduce the risk by 50%. Though the benefit of the surgery is only when it is performed before menopause. This is because of the reason that certain cancers require estrogen to grow, with no production of estrogen in the body, cancer growth is stopped and slowed.
For ovarian cancer prevention in high risk women, it has proved to reduce the risk by 60%. The procedure benefits the individual because as of now there is no test to detect ovarian cancer and it is very difficult to diagnose this cancer. Thus the diagnosis is done quite late when the cancer has developed.
It has been seen that a combined mastectomy and ovarian removal is quite beneficial and successful. These women did not develop ny cancer later nor did they require any second surgery for breast cancer.
Cryotherapy is also known as cryosurgery, in it with the use of extreme cold, cancer cells are frozen and killed. This is also useful in controlling bleeding and pain. There is a certain percentage of water content in all cells including breast cancer cells. On exposure to extreme cold, these cancer cells are transformed into crystals. These ice crystals coupled with cold destroy and kill the cancer cells.
For treatment of precancerous skin lesions and other specific cancers, cryotherapy is regularly used. Liquid nitrogen for example is used to treat early stage skin cancers. Other cancers in which cryotherapy is used are cervical, bone and prostate cancer. The procedure involves, inserting cryoprobes which are small needles are inserted into the cancerous tissue where they drip the liquid nitrogen or the argon gas. To place the cryoprobes in the cancerous tissue at the right spot, help of imaging techniques like MRI, Ultrasound, computerized tomography (CT), is taken. As the needles are inserted deep in the tissue, patients are given anasesthesia and sometimes in even mild sedative during the procedure. Cryotherapy for breast cancer is cureently at an experimental stage.