Breast cancer can spread to the rest of the body by first spreading to the patient’s lymph nodes. Lymph nodes are small, bean-shaped structures within a body’s immune system collecting fluid, waste material and more outside the bloodstream.
Cancer in the lymph nodes can be hard to notice, but in the case of an infection, inflammation, or cancer, these nodes can grow larger and present themselves as an area of interest during cancer screening. A sentinel lymph node is defined as the first node to which cancer cells are most likely to spread from a primary tumor. The surgeon finds the sentinel lymph node by performing the sentinel lymph node procedure. This is performed in the operating room by injecting the breast with a radioactive substance and/or blue dye. The surgery is done at the same time as the surgery on the breast.
The number of cancer cells in the lymph node and the number of involved lymph nodes are of key interest. In the case of very few cells in a lymph node, it may not change the treatment plan at all. But the more cancer there is in a node, the more likely it is that the cancer is growing and likely to spread, in which case your doctors will adjust the treatment plan accordingly. In some cases where the cancer has spread to the lymph nodes, your doctor may recommend removing most of the lymph nodes under the arm.
The decision to have breast reconstruction is a personal one. It depends on how you think you will feel after a mastectomy. If you think you would feel uncomfortable with a flat chest or wearing a false breast (prosthesis), you may consider breast reconstruction. If you do not want to have any more surgeries, you may choose to forgo it.
If you are considering breast reconstruction, talk with your doctor about it before your mastectomy. Your doctor can tell you whether reconstruction is an option for you, and if so, what type of reconstructive surgery might work they recommend for your circumstances. Breast reconstruction is covered by most insurance providers including Medicare and Medicaid in Kentucky according to The Women’s Health and Cancer Rights Act of 1998. Reconstruction can be performed at the time of your mastectomy or at a later date.
Factors affecting the type that is recommended for you can include:
- The size and location of the cancer, which determines the amount of skin and tissue to be removed in the mastectomy.
- The amount of tissue removed from the breast.
- If your chest tissue has been damaged by radiation therapy or aging, and is not healthy enough for reconstruction surgery.
- Potential for complications.
- Your overall health and medical history.
- Once again, be sure to discuss the common risks with your doctor before making a decision.
There are two main types of reconstruction surgery:
- Expander/implant. An expander is used to create a breast mound, and expand the skin and muscle allowing the placement of a filled breast implant.
- Autologous tissue. A person’s own body tissues are used to reconstruct a new breast mound. Reconstruction surgeries leave you with two surgical wounds: the chest and the site where tissue was removed.
You may also decide to have other procedures to improve how your new breast shape looks.
Oncoplastic surgery is a single procedure that combines cancer surgery and plastic surgery for breast cancer patients. This procedure aims to remove the area of the breast containing cancer followed by reshaping the remaining breast tissue to normal appearance.
Not all patients undergoing a form of breast conservation surgery will require this procedure. Ask your breast surgeon to learn about your personal needs in breast cancer care.
Immediate reconstruction surgery has a longer recovery time than for mastectomy alone. With autologous tissue surgery, there is a second surgery site that will need to be cared for as it heals.
It is important to know that it can take several months before the final results of breast reconstruction can be seen. Be patient as your body heals.