Currently, there are several surgical approaches to<unk> , and the type that a person decides to undergo (or whether they will decide instead to have a lumpectomy) depends on factors such as the size, location, and behavior of the tumor (if one is present), whether or not the surgery is prophylactic, and whether the person intends to undergo reconstructive surgery. * Simple<unk>  (or "total<unk> "): In this procedure, the entire breast tissue is removed, but axillary contents are undisturbed. Sometimes the "sentinel lymph node"—that is, the first axillary lymph node that the metastasizing cancer cells would be expected to drain into—is removed. People who undergo a simple<unk>  can usually leave the hospital after a brief stay. Frequently, a drainage tube is inserted during surgery in their chest and attached to a small suction device to remove subcutaneous fluid. These are usually removed several days after surgery as drainage decrease to less than 20-30 ml per day. People that are more likely to have the procedure of a simple or total<unk>  are those that have large areas of ductal carcinoma in situ or even those persons that are removing the breast because of the possibility of breast cancer occurring in the future (prophylactic<unk> es). When this procedure is done on a cancerous breast, it is sometimes also done on the healthy breast to forestall the appearance of cancer there. The choice of this "contralateral prophylactic" option has become more typical in recent years in California, most notable in people younger than 40, climbing from just 4 percent to 33 percent from 1998 to 2011. However, the possible benefits appear to be marginal at best in the absence of genetic indicators, according to a large-scale study published in 2014. For healthy people known to be at high risk for breast cancer, this surgery is sometimes done bilaterally (on both breasts) as a cancer-preventive measure. * Modified radical<unk> : The entire breast tissue is removed along with the axillary contents (fatty tissue and lymph nodes). In contrast to a radical<unk> , the pectoral muscles are spared. This type of<unk>  is used to examine the lymph nodes because this helps to identify whether the cancer cells have spread beyond the breasts. * Radical<unk>  (or "Halsted<unk> "): First performed in 1882, this procedure involves removing the entire breast, the axillary lymph nodes, and the pectoralis major and minor muscles behind the breast. This procedure is more disfiguring than a modified radical<unk>  and provides no survival benefit for most tumors. This operation is now reserved for tumors involving the pectoralis major muscle or recurrent breast cancer involving the chest wall. It is only recommended for breast cancer that has spread to the chest muscles. Radical<unk> es have been reserved for only those cases because they can be disfiguring and modified radical<unk> es have been proven to be just as effective. * Skin-sparing<unk> : In this surgery, the breast tissue is removed through a conservative incision made around the areola (the dark part surrounding the nipple). The increased amount of skin preserved as compared to traditional<unk>  resections serves to facilitate breast reconstruction procedures. People with cancers that involve the skin, such as inflammatory cancer, are not candidates for skin-sparing<unk> . * Nipple-sparing/subcutaneous<unk> : Breast tissue is removed, but the nipple-areola complex is preserved. This procedure was historically done only prophylactically or with<unk>  for the benign disease over the fear of increased cancer development in retained areolar ductal tissue. Recent series suggest that it may be an oncologically sound procedure for tumors not in the subareolar position. * Extended Radical<unk> : Radical<unk>  with intrapleural en bloc resection of internal mammary lymph node by sternal splitting. * Prophylactic<unk> : This procedure is used as a preventive measure against breast cancer. The surgery is aimed to remove all breast tissue that could potentially develop into breast cancer. The surgery is generally considered when the person has BRCA1 or BRCA2 mutations in their genes. The tissue from just beneath the skin to the chest wall and around the borders of the breast needs to be removed from both breasts during this procedure. Because breast cancer develops in the glandular tissue, the milk ducts and milk lobules must be removed also. Because the region is so large-ranging, from the collarbone to the lower rib margin and from the middle of the chest around the side and under the arm, it is very difficult to remove all of the tissue. This genetic mutation is a high-risk factor for the development of breast cancer, family history, or atypical lobular hyperplasia (when irregular cells line the milk lobes.) This type of procedure is said to reduce the risk of breast cancer by 100%. However, other circumstances may affect the outcome. Studies have shown that pre-menopausal women have had a higher survival rate after this procedure had been done. File: Examples of Custom Nipple Prostheses.Examples of custom nipple prostheses File: Discrene Breast forms.Breast prostheses used by some women after<unk>  File:BreastCancer.Mastectomy specimen containing a very large cancer of the breast (in this case, an invasive ductal carcinoma) File: Breast cancer gross appearance.Typical macroscopic (gross examination) appearance of the cut surface of a<unk>  specimen containing cancer, in this case, an invasive ductal carcinoma of the breast, pale area at the center Before surgery Before the operation, everyone will meet with the surgeon a few days before the surgery or even the day before, however, a much longer period is very beneficial since it allows the patient time for a more objective weighing of the options. Although there is some urgency in timing the surgery, the patient needs some time after the initial shock of hearing the cancer verdict; otherwise, they may later regret their decision. The extent and specific details regarding the<unk>  will be discussed along with the person's medical history. Of extreme importance will be the person's decision whether the entire breast is to be removed, or only a part of it - and that is usually much more a personal choice than a medical assessment. The medical viewpoint stresses the statistical fact of much stronger chances for cure and survival when the breast is removed completely, even when the size of the cancer is small. From the personal viewpoint, the perspective of not having the breast is very painful and difficult to accept. At this point the support of the family and of good friends can make the difference between life and death, since it is easier for friends to present the after-the-surgery future in the "matter of fact" way, thus facilitating the reasonable decision. The dilemma of the vital importance will be weighing the aesthetics and pride, against the chances of curing and surviving, which are much better when the breast is removed 100% completely. During these considerations, very painful indeed, one needs to realize that a woman's flat chest without breasts, even without nipples, does not look bad at all, nothing to feel embarrassed of, or to be ashamed by; it looks just neutral. Since the surgery is unavoidable, for people open to see the problem in this way, the choice becomes easier. Before the surgery the patient will have time to ask any questions regarding the procedure at this time and after everything is addressed a consent form is signed. Information about not eating or drinking anything beforehand will be gone over as well. The person will also meet with the anesthesiologist or the health professional who is going to be giving the anesthesia the day of the operation. Recent research has indicated that mammograms should not be done with any increased frequency than normal procedure in people undergoing breast surgery, including breast augmentation, mastopexy, and breast reduction. During surgery The day of the operation the patient will have an IV line started, which will be used to give medicine. Since this is an extensive procedure the patient will be hooked up to an EKG machine and also have a blood pressure cuff to monitor vitals and the heart rhythm throughout the whole surgery. The anesthesia will be given, which will result in the person going to sleep. The timing of the surgery all depends on the extent and what type of<unk>  the patient will be having. After surgery When the procedure is complete the patient will be taken to a recovery room where they are monitored until they wake up and their vital signs remain stable. It is normal for people that have<unk> es to remain in the hospitals for 1 to 2 nights and they are released to go home if they are doing well. The decision for discharge should be made by the doctor based on the person's overall health at the time. The person is dressed with a bandage over the surgery site that is wrapped around the chest snugly. It is common to have drains coming from the incision site to help remove blood and lymph to initiate the healing process. Patients may have to
Mastectomy
Metastasectomy
Chemoradiotherapy
Irradiation
Radiation lobectomy
Tomotherapy
Carboxytherapy
Wedge resection