FAQs – Breast Cancer Surgery

1.  What are the goals of Breast Cancer Surgery?

•  The main goal of Breast Cancer Surgery is to remove the cancer tumour and the nearby margin. The tissues near the tumour are removed because there is a chance of them being cancerous as well as to prevent the cancer from reoccurring. Other than this, breast cancer surgery is also performed to:

1.  Prevent the cancer before it occurs.
2.  Diagnose of the tumour – to determine whether it is malignant or benign. 
3. Determine the stage of the cancer.
4.  Debulk – when removal of the whole tumour is not possible.
5.  Relieve symptoms or side effects.

1. 2. What are the different types of Breast Cancer Surgery?

•  There are several types of Breast Cancer Surgery depending upon the size of the tumour and the extent of the disease.

•  Lumpectomy: In lumpectomy, only the tumour and some of the nearby margin is removed. Sometimes, even the lymph nodes under the armpits are removed. In this surgery, the breast is conserved to the extent possible. It is ideal for women who have small breasts or in whom cancer is detected at a very early stage. This surgery usually requires radiation therapy afterwards.

•  Mastectomy: Mastectomy is of two types-

• i. Partial Mastectomy: In this procedure, more tissue is removed than in lumpectomy. The tumour and the healthy tissue around it are also removed.

• ii. Total Mastectomy: In total mastectomy, the entire breast is removed, including the nipple, areola, and sentinel lymph nodes. This surgery eliminates the chances of the cancer reoccurring.

• c. Modified Radical Mastectomy: In this surgery, the whole breast is removed along with some lymph nodes in the armpit. Only the chest muscles are not removed.

• d. Axillary LN dissection: This surgery is performed to remove the axillary nodes from the underarms to determine whether the cancer has spread to the lymph nodes.

1. 3. What is Sentinel Lymph Node Dissection?

1. • Sentinel Lymph Node Dissection is a procedure to identify, remove and examine the sentinel lymph nodes (most likely the first lymph node in which the cancer spreads). The examination is performed  to find if the cancer cells are present in the node. It is an alternative to the axillary LN dissection and helps in determining the stage of the cancer.After this surgery, a patient might require more surgery to determine if the cancer is present, since this method of evaluation does not always detect the cancer.

1. 4. What should I expect from the surgery?

•  Before the surgery: Before the surgery, the doctor will prescribe some tests to determine the areas where the cancer exists and to check your health (blood test, ECG, chest X-Ray). The doctor will explain to you how the surgery will be performed and mark the operation area. You are not allowed to eat or drink anything a few hours prior to the surgery. Smoking is also prohibited during this period.

•  During the surgery: The patient is given anaesthesia and the surgery is performed. If the patient wants a breast reconstruction surgery immediately, then it is usually performed right after the cancer surgery.
•  After the surgery: After the patient wakes up, pain killers are given to relieve the pain, and a rehabilitation therapist helps her/him to regain strength.

1. 5. Why should I opt for Breast Cancer Surgery? (Benefits)

•  Benefits of Lumpectomy:

1. a. The patient does not lose her entire breast, as a part of it is still intact.
2. b. This surgery is less extensive and the patient is usually discharged on the same day.
3. c. It heals faster than a mastectomy.

•  Benefits of Mastectomy:

1. a. Radiotherapy is not needed.
2. b. Chances of the cancer reoccurring are less.

1. 6. Who will perform the Breast Cancer surgery?

•  A breast cancer surgeon performs the surgery along with a team of oncologists.

1. 7. Which surgery should I opt for?

•  The patient should first consult a doctor to see whether they have a choice between lumpectomy and mastectomy. The biggest deciding factor in this is the extent of the cancer. If the cancer has already spread to more than one site or is at an advanced stage, the patient will have to undergo a mastectomy.
•  If the patient is at an early stage and wants to retain the original size of the breast to the extent possible, lumpectomy is the best option. Nevertheless, if the patient is worried about the breast cancer returning, then she should opt for mastectomy (In which the entire breast is removed.)
•  In lumpectomy, sometimes a large area of the tissue is removed and the affected breast becomes smaller than the other.
•  Breast reconstruction surgery is available for patients who have undergone either of the two surgical procedures.

1. 8. What are the risks of Breast Cancer Surgery?

•  During surgery

1. a. There is always a risk of trouble in breathing and heart problems, when a patient is under anaesthesia.
2. b. Excessive bleeding in case of an extensive surgery.
3. c. Complications related to breast reconstruction like wound infection, flap failure etc. (If performed)

•  After Surgery

1. a. Occurrence of wound infections, which is curable by antibiotics.
2. b. Hematoma – Blood accumulates in the wound area, outside blood vessels.
3. c. Seroma – Fluid accumulates in the wound area.
4. d. There is a chance of excessive bleeding after the surgery, though it is very rare.
5. e. Swelling in the arm because of removal of the lymph nodes. This condition is also known as lymphedema.

1. 9. What is the cost of different types of Breast Cancer Surgeries?

•  Cost of lumpectomy: Rs. 170,000 – 220,000
•  Cost of total mastectomy: Rs. 400,000 – 450,000
•  Cost of radical mastectomy: Rs. 350,000 – 400,000

1. 10. What is the duration of different types of Breast Cancer Surgeries?

•  Duration of Lumpectomy: Lumpectomy takes approximately 1 hour. The patient is discharged either on the same day or the next day.
•  Duration of Mastectomy: Usually the surgery takes about 2 – 3 hours, and if the reconstruction is performed along with mastectomy then the surgery takes a longer time. After mastectomy, the patient is discharged in 1 – 3 days; but if reconstruction is performed, then the patient has to stay in the hospital for a longer time.

1. 11. What is Breast Reconstruction?

•  Breast Reconstruction is a surgery for women who have undergone mastectomy and had their breasts removed. It is also performed after lumpectomy, when a large part of the tissue is removed and the breast(s) become smaller than the original size. This surgery is performed by a plastic surgeon. The surgeon remodels the breast mound to its actual shape and size. The nipple and the areola can also be added by the surgeon. A patient might need more than one surgery for a proper reconstruction.
•  Types of breast reconstruction:

1. a. Breast implant – When the breast shape is created using an implant (filled with silicone or saline).
2. b. Using patient’s own tissue – When the breast is created by using tissues, fat, and skin from another part of the patient’s body. This is a more complex surgery.
3. c. Using both, patient’s own tissue and implant – When the breast shape is created using both silicone implants and the tissues, fat, and skin from the patient’s body.

1. 12. When can I get Breast Reconstruction done?

•  Breast reconstruction can be done immediately after mastectomy or after some time.

1. a. Immediate reconstruction is done just after mastectomy. In this surgery, you do not get as much scarring as in delayed reconstruction and it gives your breast a better appearance. Sometimes, it is also possible to preserve the nipple.
2. b. Delayed reconstruction can take place any time after the mastectomy is done; the patient can even wait for years before getting a reconstruction done. It does not delay any other cancer treatment such as radio therapy due to the extra time taken in recovering.

1. 13. Who performs Breast Reconstruction?

•  The breast reconstruction surgery is performed by a plastic surgeon. Typically, it is performed by the oncoloplastic surgeons, as they are trained in both reconstruction and breast cancer surgery. Sometimes microsurgery is required for breast reconstruction, which is performed by a surgeon who specializes in microsurgery.

1. 14. What are risks of Breast Reconstruction?

•  There are several risks related to breast reconstruction surgery.

1. a. The patient may have heart problems or trouble in breathing due to the anaesthesia.
2. b. There is a chance of infection in the wound area, but this can be treated by antibiotics.
3. c. Bleeding or bruising in the area of the surgery and the area from where the tissue was taken.
4. d. Chronic pain after the surgery.
5. e. Scars from the breast reconstruction surgery that do not heal even after a long time, known as keloid scars.
6. f. Seroma or fluid accumulating in the wound area.

1. 15. What is the cost of Breast Reconstruction?

•  The cost of Breast reconstruction surgery in India varies from Rs. 100,000 – 300,000. It depends on the type of breast reconstruction surgery performed and also on when is it done – immediately or after some time. 

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