Breast cancer is the most commonly diagnosed cancer among women in the United States. Approximately 250,000 Americans are diagnosed with breast cancer each year, with greater than 99% of them being women. Breast cancer begins when normal cells in the breast develop a mutation and start to grow uncontrolled. Over time these cells form a mass called a tumor. If the cells in the tumor look like regular healthy cells, the tumor is called benign. If the cells are unlike regular healthy cells, they are called malignant.
In general, there are 3 different types of breast cancer:
This is the most common kind of invasive breast cancer, accounting for approximately 80% of all breast cancers. It begins in the ducts of the breast but over time, it grows through the wall of the duct. Invasive ductal carcinoma does have the potentially to spread to lymph nodes and other parts of the body.
Unlike ductal carcinoma, which starts in the ducts of the breast, invasive lobular carcinoma starts in the lobules of the breast. Similar to ductal carcinoma, lobular carcinoma can grow through the lobules and has the potential to spread to lymph nodes and other parts of the body.
This is a rare form of breast cancer that can look like a skin infection with red or tender skin. It can also present as thickened skin over the breast that may develop tiny dimples. Some people describe these skin changes as resembling the skin of an orange. This form of breast cancer can be particularly aggressive, with the significant potential to spread to lymph nodes or other parts of the body.
In addition to these 3 forms of breast cancer, there are some specific breast lesions that are considered precancers or that signify that a woman is at increased risk for developing breast cancer.
DCIS occurs when abnormal cells appear in the milk ducts but have not grown through the wall of the duct. Since the tumor has not grown through the duct wall, it has not developed the ability to spread to lymph nodes or elsewhere. If left untreated, DCIS has the potential to progress to an invasive cancer. Surgery and radiation therapy may be recommended for DCIS.
LCIS occurs when abnormal cells form in the lobules (groups of glands) of the breast. Like DCIS, LCIS is not a cancer. LCIS is significant because it signifies that woman is at higher risk of developing breast cancer than the average woman. Management often involves increased surveillance so that if a breast cancer develops, it is caught early.
Surgery for breast cancer depends on the size and location of the tumor as well as multiple patient factors. At TriHealth, all breast surgery is tailored to the patient and a decision regarding the type of surgery is only made after discussing all of the potential options and obtaining input from the patient.
In general, surgical options include:
This involves using a small incision to surgically remove only the portion of the breast that contains the cancer as well as a small amount of normal, healthy breast tissue that surrounds the cancer. Other terms used to describe this surgery are “breast conserving surgery” and/or “partial mastectomy.” This is the least invasive form of breast surgery and is usually performed as outpatient surgery. This method of treatment is ideal for small, early breast cancers and result in little change to the overall appearance of the breast. Radiation is often recommended after lumpectomy to complete the treatment. There is no difference in overall survival when compared to mastectomy.
Mastectomy involved surgical removal of all breast tissue. There are many different types of mastectomy procedures but in general they can be categorized based on whether or not breast reconstruction is performed.
This involves removal of all the underlying breast tissue as well as most of the skin overlying the breast. With a simple mastectomy, breast reconstruction is not performed at the time of mastectomy but potentially could be performed in the future with additional surgery.
Similar to a simple mastectomy, all of the underlying breast tissue is removed. With a skin-sparing mastectomy, most of the skin overlying the breast is preserved with the exception of the nipple/areola complex. This incision for this surgery is in the center of the breast. Breast reconstruction is then performed by a board certified plastic surgeon during this initial operation.
Again, like a simple mastectomy, all of the underlying breast tissue is removed. With a nipple-sparing mastectomy, all of the skin overlying the breast, including the nipple areola complex is preserved. The incision for this surgery is on the underside of the breast. Breast reconstruction is then performed by a board certified plastic surgeon during this initial operation.
There are many breast reconstruction options following mastectomy. Some of these options involve insertion of a prosthetic implant, other options involve transfer of your own tissue from one area of the body to the breast. Some women chose to have mastectomy and reconstruction performed on both breasts at the same time. This is called bilateral mastectomy with reconstruction. If you are entertaining mastectomy, your breast surgeon will arrange a consultation with a board certified plastic surgeon to discuss reconstruction options. Together, your surgeons and you will decide on the best option for you.
This involves removing 1-4 lymph nodes from under the arm that are the first lymph nodes to drain the breast and would be the first site of lymph node spread, if the cancer was to spread. A negative sentinel lymph node biopsy indicates that the cancer has not spread to lymph nodes.
This involves removing all or most of the lymph nodes under the arm. This is not usually done unless it is known that the cancer has already spread to lymph nodes.