Breast Surgery - Mastectomy, Lumpectomy, Reconstruction
Mastectomies, lumpectomies and reconstruction surgery may be required if a cancer is diagnosed. VM-Med's Montreal Breast Center is what is known as a rapid diagnostic breast center; this means that patients can receive results within days of finding a suspected abnormality and those requiring surgery can usually schedule it within a few days of their diagnosis. Our multidisciplinary team of physicians – which includes radiologists, surgeons, pathologists, medical oncologists, surgical oncologists, radiation oncologists and genetic counselors, meets weekly to discuss every new cancer case.
This collaborative environment ensures that surgical options, as well as pre and post-operative treatment options, are tailored to each individual patient. All VM-Med patients meet with our oncology team before their operation in order to review proposed treatment options. Staging exams may be required before or after an operation.
What is breast surgery and what kind of operation is best for me?
Breast surgery involves removing all or part of the breast in an effort to remove a known cancer from the area. The type of surgery required depends on the stage of cancer, whether or not a sentinel node biopsy might be required, and a patient’s preference regarding her breasts. A decision on which course of action is best suited for each individual case is established between the doctor and the patient.
Lumpectomy / Partial Mastectomy
A lumpectomy – also referred to as a partial mastectomy or breast-conserving surgery – is often recommended for patients whose cancer is located in a single site. In order for a tumour to be considered localized there must be “clear margins.” Clear margins mean that the tissue around the tumour cannot contain any cancer cells. Another factor that must be considered is size; lumpectomies are generally suited for tumours that are less than 4 cm large. Many patients that qualify for a lumpectomy often chose it over a total mastectomy due to the fact that the procedure helps preserve as much of the breast as possible.
Patients eligible for lumpectomies may nevertheless elect to have a total mastectomy for a variety of reasons. Factors that should be considered include:
- Personal anxieties regarding a recurrence of breast cancer. The recurrence of breast cancer following a lumpectomy is slightly higher than with a mastectomy. Nevertheless women often find the benefits of conserving their breast outweigh this risk.
- There is a greater need for radiation with a lumpectomy to ensure that there is no more cancer. Consequently, patients not wanting to receive intense radiation treatment – whether for personal or logistical reasons – may find that lumpectomies are not a good option for them.
- Due to the radiation treatment time, patients electing to have a lumpectomy may not be eligible for certain reconstruction options. Patients concerned about this will often elect to receive a total mastectomy with reconstruction.
- If the cancer should recur, the breast will no longer be able to accept further radiation and a total mastectomy will need to be performed.
The duration of a lumpectomy surgery varies greatly however most procedures take only a few hours to complete.
When deciding whether or not to proceed with a mastectomy, several factors should be considered:
- Is removing the entire breast medically required?
- If the decision is between a mastectomy and a lumpectomy, personal anxieties regarding a recurrence of breast cancer should be considered, as recurrence of breast cancer under lumpectomies is slightly higher.
- A mastectomy can mean less radiation treatment, which can be beneficial especially to those who do not live near facilities where the treatment is available.
Total Mastectomy Surgery & Immediate or Delayed Reconstruction
During a total mastectomy either one (simple mastectomy) or both breasts (double / bilateral mastectomy), including the nipple, is removed entirely.
During the mastectomy, tissue around the tumour (the margin) is evaluated by a pathologist to ensure that it does not contain any cancer cells. This ensures that all the cancer cells around the tumour are removed during the surgery.
In addition, since the first area that breast cancer usually spreads to is the axillary lymph nodes, a portion of these may be removed during surgery in order to ensure that the cancer has not spread. This is referred to as a sentinel node biopsy. If lymph nodes are removed entirely during the surgery – known as axillary node dissection – the mastectomy procedure is referred to as a modified radical mastectomy. A modified radical mastectomy is required in the event that the cancer has spread to the lymph nodes. The finding of cancer cells in the axillary nodes can greatly influence the course of action recommended after surgery.
Mastectomy with Immediate Reconstruction
Patients can also elect to receive immediate reconstruction at the time of surgery. In this instance a general surgeon will remove the cancer and a plastic surgeon will reconstruct the breast all in one procedure. Immediate reconstruction has several benefits including:
- Patients wishing to get their breasts reconstructed after surgery do not need to undergo a second surgery.
- Psychological benefits for patients who feel more comfortable with their appearance after surgery.
Reconstruction options are discussed with a plastic surgeon prior to each surgery, to ensure the best result for each patient.
Immediate reconstruction is not always possible due to treatments such as radiation or chemotherapy. In these cases patients may elect to receive delayed reconstruction after radiation and chemotherapy are completed.
The duration of a mastectomy surgery can vary greatly depending on the type of mastectomy and on the individual complexity of each case. The operation usually lasts several hours and requires general anaesthesia.
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Why is VM-Med
the right choice?
The VM-Med Montreal Breast Center is the largest private breast center in Canada and an internationally recognized leader in breast cancer prevention, detection, diagnosis, and treatment. Every year, we diagnose and treat hundreds of new breast cancer cases and screen thousands of women for breast cancer.
VM-Med is proud to be the first Canadian member of the National Consortium of Breast Centers, a non-profit membership organization dedicated to excellence in breast health care.