Surgical treatment for breast cancer.

Being diagnosed with breast cancer is a life changing experience. Among the many decisions patients will make regarding their cancer treatment, is the choice regarding the best surgical treatment option.

The role of surgery in breast cancer treatment is to remove the tumor in the breast, as well as determine if the cancer has spread to the lymph nodes under the arm (axilla). Multiple large clinical trials have demonstrated that the overall survival rates for patients undergoing breast-conserving surgery (lumpectomy) and radiation versus total mastectomy are the same. At Huntington Cancer Center, breast surgeons work with the patient to help her decide what the best option is, based on:

  • type of tumor
  • size of the tumor
  • molecular features of the tumor (estrogen receptor, progesterone receptor, HER2/neu status)
  • overall health
  • family history
  • patient's personal preferences

Breast cancer surgery does not have to be disfiguring or deforming. Advances in surgical techniques for breast cancer have allowed women to complete their cancer treatment without sacrificing their body image or self-esteem. Balancing cancer treatment with the cosmetic outcome can be an important consideration when determining the best choice.

  • A type of surgery for women who have had all or part of a breast removed. It is performed by a plastic reconstructive surgeon.
  • The surgery rebuilds the breast mound and restores the patient’s breast shape and look.
  • The nipple and the darker area around the nipple (areola) can sometimes be saved, or reconstructed in a subsequent surgery.
  • Women who have had only the part of the breast around the cancer removed (lumpectomy) usually do not need reconstruction.
  • Most women who have had the entire breast removed (mastectomy) can have reconstruction.
  • Breast reconstruction can be done with 1) breast implants (filled with saline or silicone), 2) natural tissue flaps (using skin, fat, and sometimes muscle from another part of her own body, or 3) the combination of a flap and implant.
  • It can be performed at the time of mastectomy (immediate) or at a later point in time (delayed).
  • Because each patient and her breast cancer are unique, the ideal timing of each reconstructive surgery is unique.

Clinical trial: Decreasing pain after breast surgery.

Mastectomy with immediate breast reconstruction is associated with increased operative time, increased time in the hospital, and prolonged recovery due in part to increased pain and discomfort after surgery. Post-operative pain is treated with pain medications, which may result in side effects — including nausea, sedation, and constipation — that can slow the overall recovery process. Therefore, anesthetic techniques which reduce the side effects resulting from general anesthesia and opioid medications, while optimizing perioperative (all three phases of surgery) pain control are needed.

The pectoral nerve block is a safe, easy, and reliable nerve block which can be administered at the time of surgery, and may provide complete pain relief during breast surgery. The pectoral block has been shown to result in lower perioperative opioid consumption, and lower rates of nausea and vomiting in women with breast cancer undergoing modified radical mastectomy without reconstruction.

Huntington Cancer Center is currently studying the effect of a pectoral nerve block on postoperative pain, nausea, and vomiting, and perioperative opioid consumption in women undergoing mastectomy with immediate breast reconstruction. Results from this study will hopefully help doctors reduce post-operative pain and improve the overall experience for women who need or choose to undergo these surgeries. For more information about this clinical trial, and others being offered through Huntington Cancer Center, call (626) 397-3877.

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