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Every year about 1.6 million women (and over 10,000 men) somewhere in the world are diagnosed with breast cancer. Despite advances in breast cancer treatment, the first line of defense against this common type of cancer is removal of the tumor with a margin of healthy tissue around it. The size of the tumor determines how much tissue has to be removed.
When the tumor is less than 5 cm (about 2-1/2 inches) in diameter, sometimes the surgeon can perform breast-conserving surgery better known as lumpectomy.
The surgeon takes out the tumor and a margin of healthy tissue, usually about 1 cm (4/10 of an inch) around it. A pathologist looks at the tissue in the margin while the patient is still in the operating room, and if it contains cancer cells, the surgeon removes more tissue.
This procedure is not possible if:
- The breast is small.
- The tumor is more than 5 cm in diameter.
- There is cancer in multiple locations.
- It is not possible to give radiation therapy after surgical treatment.
- The patient has already received radiation therapy in the location where the tumor is found.
- The patient is a woman in the first or second trimester of pregnancy.
- The pathologist keeps finding cancer cells in repeated removal of tissue during the procedure.
When lumpectomy is not possible, then the surgeon may have to perform mastectomy.
Mastectomy is the removal of the entire breast. All of the breast is removed, sometimes along with nearby tissue.
In a simple mastectomy, sometimes called a total mastectomy, the surgeon removes the entire breast, including the nipple, but not the lymph nodes or the muscle tissue underneath the breast. Since 60% of women who develop cancer in one breast also develop it in the other, even if the other breast is not found to contain cancer, it may be removed in a procedure known as a double mastectomy.
This procedure is performed when a test of sentinel lymph nodes finds the presence of cancer metastisized from the breast. The decision to perform a radical mastectomy is made on the basis of the pathologist's report during surgery.
Sometimes the surgeon performs a skin-sparing mastectomy, leaving the nipple intact. This procedure is only used when immediate breast reconstruction is planned, while the patient is still in the operating room. But how can a breast be replaced.
Older Techniques of Breast Reconstruction
Before about 1950, reconstruction of the breast after cancer surgery was not possible. Women were encouraged to wear "falsies" to give them a normal curvature at least when they were clothed.
In the 1960's, surgeons started using a procedure called expander implant breast reconstruction. The surgeon placed a silicone breast implant in the breast during surgery, but only inflated it some weeks later when the skin had healed sufficiently to withstand the procedure. The silicone produced a mound of flesh but could not give the breast normal color or feel or a nipple.
In the early 1980's, surgeons started using a procedure called the transverse rectus abdominus myocutaneous or TRAM reconstruction technique, removing muscle from the patient's thigh or buttocks and placing it under a flap of skin left during mastectomy. The procedure was and is usually successful, but since it is essentially two surgeries at the same time, very painful.