A breast cancer diagnosis can fill any patient with uncertainty and doubt, especially if they hear they need surgery. Greenwich Hospital Chief of Surgery Barbara Ward, MD, Medical Director of the Breast Center at Smilow Cancer Hospital Care Center in Greenwich, said when it comes to breast cancer surgery, no question is too trivial.
“I think it’s great patients come with questions, and they want to participate in the decision making,” Dr. Ward said.
She and Yale Medicine Breast Surgical Oncologist Alyssa Gillego, MD, answered some common questions patients have, and shared how patients can prepare for surgery.
What are the different types of surgery for breast cancer?
There are two types of surgery for breast cancer. The first is lumpectomy, which is synonymous with partial mastectomy. This surgery is for smaller cancers and includes part of the breast.
The other surgery is mastectomy. The traditional approach to mastectomy is removing the nipple with the breast, but more recently, nipple sparing mastectomy has become more popular.
For invasive cancers, some lymph nodes are removed. This is called sentinel node biopsy or sentinel node excision. The node is removed and examined to see if cancer has left the breast and gone to the lymph nodes.
What are the risks of surgery?
One of the main risks of breast cancer surgery is lymphedema, which is swelling of the arm. The risk for lymphedema can be as low as 5%, but some patients such as those who are overweight are at a higher risk. At Greenwich Hospital, we have a lymphedema screening program and patients are evaluated for this preoperatively and then again after surgery.
Another risk is for hematoma or bruising in the breast. A large hematoma may require a patient to return to the operating room. There is also a small risk of infection, which can happen for all surgeries.
Lastly, there are potential changes to the size, shape, and appearance of the nipple or breast.
What are the benefits of surgery?
Surgery is still one of the mainstays for the treatment of breast cancer. For certain types of cancers, the importance of chemotherapy and other targeted therapies have come to the forefront of cancer care. However, we are not at a place yet where surgery is no longer necessary.
While surgery is often the cornerstone to breast cancer treatment, it’s just one part of a multidisciplinary treatment plan that involves medical oncology, radiation oncology and sometimes plastic surgery.
Is radiation needed in addition to surgery?
No one treatment plan is right for every patient, and we are focused on individual care. However, radiation typically follows a partial mastectomy except for older patients who are over 70. It is also considered in a setting of a mastectomy when the tumor is larger, or the cancer has spread to regional lymph nodes.
When is reconstructive surgery an option?
In the case of partial mastectomy, if a large area of the breast is removed, one could consider oncoplastic surgery, which is surgery that involves both a breast surgeon and plastic surgeon to reconstruct part of the breast. The main types of reconstruction are implant based reconstruction and tissue reconstruction using tissue from the person’s own body. There’s also nipple reconstruction, which can involve a small operation to create the nipple bud or a tattoo.
What happens on the day of the surgery?
This depends on the operation, but patients should expect to spend the day at the hospital and may spend the night. Some patients can go home the same day. After surgery, some patients are sent home with a wrap that closes in the front with Velcro to help them feel secure.
What does the recovery look like?
After partial mastectomy, the pain should be mild for most people and moderate for others. Typically, we can manage pain with over-the-counter medicine like Tylenol.
Once pathology reports are done, we can meet with patients in about two weeks to review their next steps for care. If a plastic surgeon is involved, they will meet with the patient sooner to go over drain and wound care.
What are some common questions patients typically ask before surgery?
Patients want to hear that they are going to be OK, and as breast cancer surgeons, we always go into every surgery optimistic. The only way to approach breast cancer is that you are going to beat it, and we are in our patients’ corner every step of the way.
After surgery, some patients ask what they can do to keep the cancer from coming back, and that’s a great question to ask as well.
“There’s good evidence that maintaining a normal weight or healthy BMI can decrease recurrence as well as regular, moderate to high intensity exercise can decrease risk of recurrence,” Dr. Gillego said.
What else can patients do to prepare for surgery?
It’s never a bad idea to get a second opinion. Approaches can change, especially with a high-risk cancer. Sometimes, patients may be eligible to participate in a research opportunity. Even if you hear the exact same thing from a different surgeon, that’s not a waste of time.
Don’t be afraid to lean on resources after treatment is complete. We believe survivorship starts on day 1, and that starts with a framework of what patients can do to optimize their health.
Learn more about the survivorship program at Yale New Haven Health.
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