Mastectomy and breast conservation surgery

The surgical procedures most commonly referred to by the term mastectomy are total (simple) mastectomy, in which the surgeon removes the whole breast but does not remove lymph nodes, and modified radical mastectomy. in which the surgeon removes the breast, all lymph nodes under the arm, and the lining over the chest muscles. Simple mastectomies are used primarily for noninvasive cancers while modified radical mastectomies are used when there is a possibility of cancer having spread to the lymph nodes.
In a breast conservation surgery, the tumour along with a surrounding margin of normal breast tissue is removed. However radiation therapy is essential after breast conservation surgery.

Treatment of lymph nodes under arm

If there is a suspicion of lymph nodes being involved with cancer, then all the lymph nodes are removed. This is called axillary lymph node dissection. This causes some post operative complications like- swelling in the arm (known as lymphoedema), seroma (persistent fluid collection in the armpit), tingling numbness and pain in the upper inner arm and restriction of shoulder movement. To avoid these complications, a procedure called sentinel node biopsy is used, in which a dye is injected around the tumour before surgery and the first or primary nodes which are draining that area are identified and removed. They are then sent to the pathologist. If the pathologist reports the nodes as having no tumour cells, then nothing more is done, If the pathologist reports the nodes as positive for tumour cells, then complete lymph node dissection is done. In this way, unnecessary axillary dissection can be avoided for patients with negative lymph nodes in the armpit.

Breast reconstruction

If complete removal of the breast (mastectomy) is required, then reconstruction of the breast can be done. This can be done as an immediate procedure at the time of mastectomy or delayed procedure which is after completion of all treatment. Reconstruction provides emotional and psychological benefit to the patient apart from the obvious cosmetic improvement. There are a number of options for reconstruction- autologous (in which the other body tissues are used to artificially reconstruct the breast) and implant based ( in which silicon implants are used to reconstruct the breast). A number of factors affect the choice of reconstruction like- the volume of breast to be reconstructed, skin elasticity, tumour size and location, need for radiation, body habitus etc.