Breast surgery can be frightening because of the association with cancer.  However,
80% of breast lumps are benign. Benign conditions such as breast abscess,
fibroadenomas, fibrocystic disease, breast pain and nipple discharge may require
surgery for diagnosis and treatment. Surgery is also an important part of the
treatment of breast cancer.

Diagnosis
     It’s important to be familiar with your breasts and to work closely with your doctor or
healthcare professional (someone with an expertise in breast care) to detect any
tumors early. Early detection of breast cancer is truly the key to a longer, healthier
life.  Regular check-ups to confirm that your breasts are healthy will bring peace-of-
mind to you and your loved-ones.  Regular check-ups should include the following: 1)
Monthly breast self-exam (BSE); 2) Yearly clinical breast exam (CBE) by a healthcare
professional; and 3) Yearly mammograms beginning at age 40 (if you have a family
history of breast cancer, ask your doctor if you should begin mammograms earlier
than age 40).

Biopsy
     If an abnormality is discovered, a biopsy may be needed to determine if it is benign
or cancer. In a biopsy, the doctor removes some of the suspicious tissue and sends
it to the laboratory for analysis. This biopsy of breast tissue further helps physicians
make a diagnosis and plan appropriate follow up or treatment. A biopsy can often be
done less invasively with a needle (core needle biopsy). However, sometimes
surgery is needed to obtain an adequate biopsy.

     If a cancer diagnosis is made, pathologists microscopically determine the type, or
histology (there are many kinds of breast cancer), the grade (how aggressive the
cancer is), the cancer stage (how large and widespread the cancer is), and whether
or not the cancer is localized (in situ) or invasive.
Fortunately, not all suspected diagnoses turn out to be cancer. Sometimes the
pathologist determines the patient has a benign condition or perhaps one that may
be a precursor to cancer and needs to be monitored.

Lumpectomy
     Lumpectomy is the most common form of breast cancer surgery today. The surgeon
removes only the part of your breast containing the tumor (the “lump”) and some of
the normal tissue that surrounds it. Lymph node sampling is important in staging
breast carcinoma and can usually be performed by sentinel node biopsy. The
sentinel node is the first lymph node that filters fluid from the breast. If the sentinel
node is positive a full axillary node dissection may be needed. All the tissue removed
from your breast is examined carefully to see if cancer cells are present in the
margins—the normal tissue surrounding the tumor.  

     If cancer cells are found in the margins, extending out to the edge of the breast
tissue that was removed, your surgeon will do additional surgery (called re-excision)
to remove the remaining cancer. Most women receive five to seven weeks of
radiation therapy after lumpectomy, in order to eliminate any cancer cells that may
be present in the remaining breast tissue

Mastectomy
     Surgery to remove the breast (mastectomy) is important for women with operable
breast cancer who are not candidates for breast conserving surgeries (lumpectomy).
There are different variations on the procedure:

     A modified radical mastectomy removes the entire breast and armpit lymph nodes,
but leaves the underlying chest wall muscle intact.

     A total/simple mastectomy involves removal of the whole breast but not the armpit
lymph nodes or chest wall muscle

Chemotherapy
     Chemotherapy is a systemic therapy; this means it affects the whole body by going
through the bloodstream. The purpose of chemotherapy and other systemic
treatments is to get rid of any cancer cells that may have spread from where the
cancer started to another part of the body.

     Chemotherapy is effective against cancer cells because the drugs love to interfere
with rapidly dividing cells. The side effects of chemotherapy come about because
cancer cells aren’t the only rapidly dividing cells in your body. The cells in your blood,
mouth, intestinal tract, nose, nails, vagina, and hair are also undergoing constant,
rapid division. This means that the chemotherapy is going to affect them, too.

     Still, chemotherapy is much easier to tolerate today than even a few years ago. And
for many women it’s an important “insurance policy” against cancer recurrence. It’s
also important to remember that organs in which the cells do not divide rapidly, such
as the liver and kidneys, are rarely affected by chemotherapy. And doctors and
nurses will keep close track of side effects and can treat most of them to improve
the way you feel.

     Chemotherapy can be given by mouth (orally) in pill, capsule, or liquid form. It can be
given intravenously, through a thin needle inserted into a vein in your hand or lower
arm. For some women, chemotherapy can be given through a port (sometimes
referred to by a brand name, such as Port-a-cath or Mediport) that is inserted in the
chest during a brief, same-day surgery. Even intravenous drugs (those not taken by
mouth) can vary, from a single, quick injection to a slow drip or “infusion.”
Chemotherapy can also be given at different times during your treatment.  

     Most women have chemotherapy after their surgery.  However, for some patients
with large tumors chemotherapy is recommended before surgery to shrink the tumor
making surgery easier and more effective.  This is called neoadjuvant
chemotherapy.  How you receive your chemotherapy depends on the regimen you
and your oncologist select.

     It’s important to remember that every woman’s ideal treatment plan is different. Be
aware that your “chemo” regimen may be different from someone else’s, based on
very individual—and sometimes subtle—breast cancer factors. These include: lymph
node involvement, tumor size, hormone receptor status, grade, and oncogene
expression. Be prepared for your doctor to recommend a combination of
chemotherapies—together or in a series.