For women diagnosed with breast cancer, surgery is performed to treat the disease. Many options are available and whenever possible, women are offered a chance to have a lumpectomy (or breast-conserving surgery.) Below are the some surgery types that pertain to a breast cancer treatment protocol.
When a woman finds a lump in her breast, or a mammogram reveals a suspicious area, a biopsy is performed to determine whether cancer is the cause. A surgeon performs a biopsy to remove a tissue sample or the entire lump, which is then reviewed under a microscope. Breast biopsies may also be done with a needle, depending on the type and location of the area in question.
Lumpectomy is surgery to remove a breast tumor and some of the surrounding tissue. This surgery is performed in a hospital under local anesthesia and a mild sedative, and does not require an overnight stay. Lumpectomy is appropriate for women who have single tumors under 4 cms, with surrounding margins of tissue that are free of cancerous cells. When followed by radiation, lumpectomy is as effective as mastectomy.
Mastectomy (Breast Removal)
Mastectomy removes the entire breast, either to treat breast cancer or to prevent it in high-risk individuals. Mastectomy is recommended for women whose cancers cannot be completely removed by lumpectomy, who cannot tolerate radiation, or who have two or more areas of cancer in different areas of the same breast. This surgery is performed under general anesthesia and patients usually spend one night in the hospital.
Total or simple mastectomy:
A total mastectomy removes the entire breast, including the nipple, areola, skin and the fatty tissue underneath the skin. Total mastectomy is appropriate for women with DCIS and those who choose prophylactic mastectomy.
Modified radical mastectomy:
A modified radical mastectomy removes the entire breast, including the nipple, areola, skin and the fatty tissue underneath the skin, and some underarm lymph nodes. Currently the most commonly performed mastectomy, modified radical mastectomy is recommended when invasive cancer is present.
A radical mastectomy removes the entire breast, all underarm lymph nodes and the chest muscle. Considered standard care for breast cancer years ago, this surgery is almost never used now.
Reconstruction (Breast Restoral)
After mastectomy, women may choose to wear prostheses or not, or have their breasts surgically reconstructed.
When reconstruction is performed immediately with mastectomy, the nipple and areola are typically removed along with the breast tissue, but most of the breast skin is kept to hold an implant or a flap of tissue from elsewhere on the body.
Women who have immediate reconstruction need a longer hospital stay (usually a few days) than with mastectomy alone, and a longer recovery (between 3-6 weeks), depending on the type of reconstruction.
Women who are not at high risk for breast cancer or recurrent cancer in the nipple/areolar area may be candidates for one of the following skin-sparing mastectomy procedures:
Areolar-sparing mastectomy: preserves the areola and the remaining breast skin, but removes the nipple.
Nipple-sparing mastectomy: preserves the nipple and remaining breast skin, but removes the areola.
Areolar/nipple-sparing mastectomy: removes breast tissue through an incision in the fold under the breast, preserving the nipple and areola. This is also referred to as subcutaneous mastectomy.
Here are some of the techniques:
3-D Areola Pigmentation: This procedure is for patients who have had breast reconstruction after a mastectomy or lumpectomy. Cosmetic tattooing techniques and color pigments are used to create the appearance of an areola. For a unilateral mastectomy patient, this process helps the reconstructed breast to match the natural breast. For patients with bilateral breast reconstruction, both areolas are recreated. Areola complex simulation can be achieved with or without a nipple button created by the surgeon.
Areola Scar Camouflage: Many breast operations require one or more incisions at or around the edge of the areola which may produce scarring. The most common peri-areolar scars are from breast augmentation or reduction surgeries. A scar’s appearance can be softened, blended, or reduced by tattooing the areola scar using corrective pigment camouflage techniques.
Areola Size or Color Adjustment: The color of an areola can be darkened, balanced, or enhanced with tattooing. The process helps women who have discolored or lightened areolas after breastfeeding or patients who have had areola graft surgery. Patients with skin discoloration disorders (e.g. Vitiligo) can also benefit from areola tattooing. Also, individuals who have not had breast surgery but are self-conscious about their areola color or size (too light or too small) may choose this procedure to adjust their appearance.
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