Surgical Procedures

Breast Biopsy is an outpatient procedure where a small piece of tissue is taken.  This is necessary for some tender or growing breast lumps.  It might be necessary after a needle biopsy to obtain more tissue for accurate diagnosis.  The procedure is done in the hospital or surgery center and takes less than an hour.  Dissolving stitches are used.  Pain medicines are prescribed but usually only needed for a 1-2 days.  If the biopsy is performed on a Thursday or Friday, you can return to work on Monday.

Lumpectomy and partial mastectomy are the terms for removal of the breast cancer and a small amount of tissue around the cancer.  In most cancer surgery, lymph nodes are also removed.  The location of lymph nodes is under the arm (armpit area).  This biopsy is called a sentinel lymph node biopsy (see below).  The procedure is done in the hospital or surgery center and takes about an hour.  Dissolving stitches are used.  Pain medicines are prescribed but usually only needed for a few days.  If the biopsy is performed on a Thursday or Friday, you can return to work on Monday.

Sentinel Lymph Node Biopsy is the removal of one to three lymph nodes under the arm.  The sentinel node is the first n ode that “guards” against the spread of cancer. If there is no cancer in the sentinel node there should not be any in the other nodes. Before sentinel node biopsy, women had the majority of the lymph nodes removed under the arm (axillary dissection) with an increased risk of long term swelling or pain.  Recent studies show that an axillary dissection might not be needed in all cases after a positive sentinel lymph node biopsy. Sentinel node biopsy is performed at the same time as either a lumpectomy or mastectomy.  Rarely is there a need to perform the node biopsy separately in two surgical procedures. First there is an injection in the breast skin that is absorbed by the lymph vessels.  These vessels channel to the sentinel node which is then removed through an incision under the arm. No drains are needed for this procedure.

Skin Sparing Mastectomy is the removal of the breast leaving as much skin as possible for reconstruction.  It is usually performed with a sentinel node biopsy (see above) unless there are enlarged lymph nodes.  If enlarged lymph nodes are found containing cancer then 2/3 lymph nodes are removed.  Reconstructive breast surgery begins during this procedure.  Implants or your own fatty tissue can be used to form a new breast.  A new nipple and areola can also be made at a second procedure.  Drains are placed and usually removed in 7-14 days in the office. One stays in the hospital for 1-2 days and needs pain medicines for 3-5 days.

Nipple sparing or Areolar sparing mastectomy is the removal of just the breast tissue. With nipple sparing mastectomy, the inicision is usually in the breast fold under the breast or around the areola. The natural nipple and areola remain. The Areolar sparing mastectomy is the removal of the breast tissue and the nipple. The incision is usually in the fold under the breast with a circular incision removing the nipple. Other names for these procedures include total skin sparing, NAC sparing.

Modified Radical Mastectomy is the removal of the breast tissue and most of the lymph nodes under the arm.  This is performed when cancer has spread to the lymph nodes at the time of surgery.  Breast reconstruction after mastectomy can be done if desired. Drains are again placed and usually removed in 7 days in the office. One stays in the hospital for 1-2 days and needs pain medicines for 3-5 days.

A mediport is a device inserted under the skin into a vein for chemotherapy.  It can be placed at the same time as the lumpectomy or mastectomy or at a separate surgery. Radiologists also place these in the procedure area.  The port is removed in the office at the completion of chemotherapy.