Houston Methodist. Leading Medicine.
Houston Methodist. Leading Medicine

Surgical Options

Patient Information

Appointment Scheduling

Hours:
Monday - Friday,
7:00 a.m. - 5:30 p.m.
Saturday,
7:10 a.m. - 3:30 p.m.

As part of your treatment, you and your breast surgeon will develop a surgical plan that may include a combination of not only breast surgery but also lymph node surgery.

The two surgeries will be completed at the same time; however
they are referred to as individual surgeries because there are
several possible combinations of the two surgeries.

Lymph Node Evaluation

Breast cancer tumors can shed cancerous cells into the nearby lymph nodes. Your breast surgeon may remove lymph nodes to be examined under the microscope. Identifying the presence or absence of cancer cells in the lymph nodes is an essential part of the staging process and aids in creating a treatment plan.

Sentinel Lymph Node Biopsy

This is a diagnostic procedure to identify if there is cancer in the lymph nodes. Sentinel lymph nodes are the lymph nodes that are closest to the tumor site. They drain lymphatic fluid from the area around the breast which is the reason they are more likely to contain cancer cells. A patient will usually have 1 to 4 sentinel nodes removed for testing.

Axillary Lymph Node Dissection

This procedure is to remove lymph nodes that are known to have cancer. Typically about 10 axillary (underarm) lymph nodes are removed for testing.

Breast Cancer Treatment

Lumpectomy

A lumpectomy is an operation to remove only the lump and some surrounding tissue from the breast. A lumpectomy can be performed as either a diagnostic or treatment tool.

Diagnostic tool — to discover the type of cancer present

If the lumpectomy is being performed as a diagnostic tool, the surgeon will remove part of the tumor and some surrounding tissue. Sometimes, the surgeon will also remove lymph nodes from your axilla (underarm). The lump and the lymph nodes that have been removed will be sent off to the laboratory for testing. This testing process is called staging — meaning that the stage of cancer present will be identified.

Treatment tool — to remove a cancerous tumor

For some types of cancer a lumpectomy is a successful treatment option because it removes the cancerous lump. The size of the lump present will determine the amount of tissue surrounding the lump that needs to be removed.

For patients who have had a lumpectomy, depending on the location of the tumor and size of the breast, partial breast irradiation may be a treatment option. With this technology, breast cancer can be treated in five days instead of six to seven weeks. Candidates for this type of treatment require certain criteria which can be identified by your physician.

Mastectomy

A mastectomy is the removal of the entire breast. One of the benefits of a mastectomy is that it decreases the risk of recurrent breast cancer.

It is possible for women to have breast reconstruction surgery at the same time as the mastectomy. This is called immediate reconstruction, but is not recommended for all women. Women who cannot have immediate breast reconstruction can have delayed reconstruction weeks to years after their mastectomy. Patients typically stay in the hospital one or two nights following a mastectomy, with some additional recovery time once at home.
There are several types of mastectomies, including:

  • Simple/Total Mastectomy:Often chosen for prevention, all of the breast tissue, areola and nipple are removed. This procedure is often combined with a sentinel lymph node biopsy.
  • Modified Radical Mastectomy:All of the breast tissue and some of the skin of the breast including the nipple and areola, as well as all of the axillary (underarm) lymph nodes are removed.
  • Skin-Sparing Mastectomy:All of the breast tissue, areola and nipple are removed. However, nearly all of the breast skin is left in place making simultaneous breast reconstruction ideal.
  • Nipple-Sparing Mastectomy:The surgeon works through a small incision to remove the breast tissue while leaving the nipple, the areola, and all of the skin of the breast intact. The results of breast reconstruction are best with this type of mastectomy because the patient retains her nipple and areola.

Breast Reconstruction

Women can choose to have breast reconstruction surgery after a mastectomy to restore the breast. Breast reconstruction can also be done to restore the shape and volume of a breast following a lumpectomy and radiation treatment. Breast reconstruction can be done using the patient's own natural tissue from their belly, buttocks or back or with an implant.

Some types of breast reconstruction include:

[+]Breast Implant

[+]DIEP Flap

[+]TRAM Flap

[+]SIEA Flap

[+]SGAP or IGAP Flap

Insurance Coverage

Breast reconstruction surgery is not considered cosmetic surgery. Breast reconstruction is performed to restore a breast that has been removed by a mastectomy or distorted following lumpectomy and radiation. Studies have shown that breast reconstruction improves the well being and self esteem of women. Breast reconstruction is considered an integral part of breast cancer treatment. For this reason, The Women's Health and Cancer Rights Act was enacted in 1998. This federal law mandates insurance coverage of breast reconstruction following a mastectomy.

It is best for you to discuss the decision with your surgeon and breast care team. Each procedure has advantages and the decision will depend on your body type and current treatment.