Excisional biopsy is the most involved kind of biopsy. It attempts to remove the entire suspicious lump of tissue from the breast. This is the surest way to establish the diagnosis without missing the cancer tissue (winding up with a false negative). Both incisional and excisional biopsies can be done in an outpatient center or hospital, using anesthesia. The purpose of this procedure is to make a diagnosis. Even if the lumpectomy takes out all of the cancer in the breast with clear margins, if breast cancer is diagnosed, additional surgery may be required.
A Lumpectomy or Partial Mastectomy is a surgical procedure performed on a breast abnormality with a previous diagnosis by a needle biopsy. The suspicious lump and some surrounding tissue is excised and analyzed by pathology. Breast lump removal is generally completed as an outpatient surgery. You will be given a form of anesthesia. The procedure generally takes about 1 hour. The surgeon makes a small incision on your breast. The cancer and some of the normal breast tissue around it is removed. A pathologist examines a sample of the removed tissue to make sure all the cancer or abnormality has been taken out.
With a diagnosis of cancer, sometimes small metal clips will be placed inside the breast to mark the area of tissue removal. This makes the area easy to see on future mammograms. It also helps guide radiation therapy, when needed. The surgeon will close your skin with stitches, which are under the skin and dissolvable. Your doctor will send the “lump” to a laboratory for more testing.
Sentinel Lymph Node Biopsy
A Sentinel Lymph Node Biopsy is the removal and examination of the sentinel node(s) (the first lymph node(s) to which cancer cells are likely to spread from a breast tumor). To identify the sentinel lymph node(s), radiology will inject a radioactive tracer the day prior to surgery, that will travel to the first lymph node. Your breast surgeon will inject a blue dye in the breast, right before surgery, which will also travel to the first lymph node. The surgeon then uses a probe to find the sentinel lymph node(s) containing the radioactive substance and stained with dye. The surgeon then removes the sentinel node(s) to check for the presence of cancer cells, which will be sent to pathology for evaluation.
An Axillary Dissection is a surgery to remove multiple lymph nodes found in the axilla (armpit) of the side of diagnosed breast cancer.
A Mastectomy is a surgery to remove the entire breast. Most of the time, some of the skin and the nipple are also removed. The surgery is most often done to treat breast cancer. Before surgery begins, you will be given general anesthesia. This means you will be asleep and pain-free during surgery. There are different types of mastectomies. Which one your surgeon performs depends on the type of breast problem you have. Most of the time, mastectomy is done to treat cancer. However, it is sometimes done to prevent cancer (prophylactic mastectomy). The surgeon will decide which of these options are best for you, and will perform one of these operations:
- Nipple sparing mastectomy: The surgeon removes the entire breast but leaves the nipple and areola (the colored circle around the nipple) in place. If you have cancer, the surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread. This is usually performed in conjunction with breast reconstruction, with a plastic surgeon (who specializes in breast reconstruction).
- Total or simple mastectomy: The surgeon removes the entire breast along with the nipple and areola. If you have cancer, the surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread. This can be done with or without breast reconstruction.
- Modified radical mastectomy: The surgeon removes the entire breast with the nipple and areolar along with some of the lymph nodes underneath the arm. This can be done with or without breast reconstruction.
- Skin-sparing mastectomy: The surgeon removes the breast with the nipple and areola with minimal skin removal. If you have cancer, the surgeon may do a biopsy of lymph nodes in the underarm area to see if the cancer has spread. This can be done with or without breast reconstruction. One or two small plastic drains or tubes are very often left in your chest to remove extra fluid from where the breast tissue used to be.
A plastic surgeon may be able to begin reconstruction of the breast during the same operation. You may also choose to have breast reconstruction at a later time. If you have reconstruction, a skin or nipple sparing mastectomy may be an option.
Mastectomy generally takes about 2 to 4 hours, depending on the surgery selected.
Oncoplastic surgery is a surgical approach to treating breast cancer that can improve the cosmetic outcomes for many patients. The surgeons combine breast cancer tumor removal and plastic surgery techniques during the same surgical procedure. By doing this, patients can have their cancer removed while preserving the physical appearance of their natural breasts at the same time.
Hidden Scar™ Trained Surgeons
Both Dr. Gleason and Dr. Montes are Hidden Scar™ trained breast care surgeons. Each year, approximately 253,0001 women are diagnosed with breast cancer that requires surgery. Many are unaware of all the surgical options available, including less invasive approaches that can help restore their self-image and allow them to begin the emotional healing process. Five-year survival rates for breast cancer are increasing. As such, survivorship is becoming increasingly important. Scars have a significant impact on survivorship in that they impact the survivors’ body image, intimacy, confidence, and mental health.
Hidden Scar™ Breast Cancer Surgery allows Dr. Gleason and Dr. Montes to remove the cancerous tissue through a single incision made in a hidden area, preserving the natural shape of the breast while reducing visible scarring. Patients who undergo this approach experience optimal clinical and cosmetic outcomes, and are at no higher risk of recurrence than patients who undergo any other surgical technique.
- American Cancer Society. Breast Cancer Facts and Figures 2017-2018