Most women and men with large tumor/Stage 3 breast cancer will need some type of surgery. Different types of surgery are available based on the size and location of the tumor, how aggressive and/or invasive the disease is, and whether there is evidence cancer has spread to the lymph nodes.
All breast cancer patients will require either a sentinel node biopsy or an axillary dissection, which is completed during surgery. The nodes are analysed under a microscope by a pathologist to see if there is any cancer. If there are no palpable nodes you will have a sentinel node biopsy. You will be injected with a radio tracer – nuclear medicine – before surgery and a blue dye during surgery to help the surgeon find the sentinel nodes. If your doctor confirms nodes are involved, you will require axillary dissection. Risks associated with an axillary dissection are lymphedema (15%) and permanent numbness (30%).
The surgical options presented will largely depend on your surgeon’s training and confidence with certain procedures. If there is a surgical procedure that you feel is right for you, but your surgeon is uncomfortable performing, you are allowed to ask for a second opinion, or even a third opinion. This is your decision and a highly personal one. However, it is important to appreciate that your individual case may be more time sensitive than others, and you should always make any medical decision in collaboration with your medical team.
Most surgical procedures will leave a visible surgical scar on your breast. If you are planning multiple surgeries it may be worth talking to your surgeons about scar placement, so that your end result has symmetry.
Any surgery to remove cancer may potentially limit your reconstruction options. Most mastectomy patients can have reconstruction done at the same time (immediate reconstruction). Some delay reconstruction until skin and tissue have completely healed from a mastectomy (delayed reconstruction). Someone requiring a lumpectomy can have oncoplastic surgery to restore a natural breast shape and symmetry at the same time as removal of the cancer, or may decide on a delayed reconstruction. There are multiple advantages and disadvantages for each approach.