Lesson 3: Surgery
Breast conserving surgery
Breast Conserving Surgery
Twenty years ago, there was no choice for women with breast cancer. You would have a mastectomy. End of discussion. Fortunately for women today, there are several options available. There are surgical procedures known as "breast conservation", literally saving the breast. These include lumpectomy and re-excision or wide excision. Other names for these procedures include partial mastectomy, wedge resection and quadrantectomy. The goal of all these surgeries is to remove the tumor as a whole and to leave as much of your breast intact as possible. http://www.breastcaresite.com/
In 1996, I had a lumpectomy. This was done on an outpatient basis, at the breast center. The surgery was done in a "mini" operating room in a reclining chair. The surgeon numbed the area, removed the cyst and stitched me up. The nurse walked me to the recovery area, where I munched on cookies and drank tea. I had a band-aid on the incision and wore a sports bra. Two days later, the results were in - a benign cyst. Whew! I had the surgery on Thursday and went back to work on Monday.
In November 1998, I had another lumpectomy. I was cool as a cucumber. I had "been there, done that". This time, the results were different - invasive ductal carcinoma. Another surprise was that I had "dirty margins". When the surgeon removes the tumor, he also removes an area of tissue surrounding the tumor to make sure that he has gotten all of the cancer cells. If pathology reports that the cancer cells are all the way to the edges of the tissue sample, then the rule of thumb is that they do not feel that they have removed all the cancer. This time I was to have my wide excision (the nurse called it a quadrantectomy) in the hospital's operating room, since they would also be doing a sentinel node biopsy and axillary dissection (see previous Lessons for more detail). This time, I was given "twilight sleep" - enough anesthesia to make you forget the pain, but still be able to mumble a few words. I awoke in the recovery room, and spent the night in the hospital. My overnight stay was due to the axillary dissection, not because of my wide excision. Back home, tight sports bra, larger area bandaged. Stayed home for one week, again, due to axillary dissection more than the wide excision. Two shocks resulted from this surgery: my poor little breast was so black and blue and misshapen that I cried the first time I saw it in the mirror. I blame the shock on my own ignorance and the failure of the medical team to explain it to me more comprehensively. Yes, they took a quarter of my already small-to-begin-with breast and when the remainder was stitched back up, it was all out of whack. The bigger shock was the fact that I still didn't have "clean margins" and would have to finally have a mastectomy.
The surgeon had offered to do a mastectomy when the first pathology report came back, but I wanted to try to save my breast if possible. He agreed that I was a good candidate for a wide excision. Not all women are. You will not generally be offered breast conserving surgery if:
* You have had previous radiation to the same breast
* You have several areas of cancer in the same breast
* Your tumor is large and breast is small and the surgery would be disfiguring (this is a judgement call)
* They have made several attempts to remove the tumor and get "clean margins" and can't
* Certain diseases, such as lupus, would hinder your ability to deal with radiation
* Pregnant women should not usually have radiation therapy
* You don't want to make the daily and lengthy commitment to follow-up radiation
* A mastectomy would give you, personally, greater peace of mind
Breast conserving surgery has made great strides in the past decade. Most women will be offered a combination of such surgery in conjunction with radiation and/or chemotherapy. Some women will still require, or opt for, a mastectomy. Many studies have been done documentating the efficacy of these procedures. The survival rates for breast conserving surgery are considered to be comparable to mastectomy. Please remember that although a diagnosis of breast cancer is devastating, it is not a death sentence. Most women not only survive the surgeries and therapies involved, but go on to live life to the fullest, enjoying every precious moment.
