Breast Surgery

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At Baystate Health, our breast surgeons are experienced specialists in their field. They are an important part of your breast health team and work closely with specialists in radiology, chemotherapy, and radiation therapy to provide seamless care.

Your team will guide you through the entire process of surgery, educating you before your procedure and coordinating your follow-up care – including plastic and reconstructive surgery if necessary.

Our breast surgeons are trained in the latest advancements for both benign and cancerous breast conditions, such as nipple sparing mastectomy, radioactive seed localization (RSL), and oncoplastic surgery.

Surgery For Benign (Non-Cancerous) Breast Conditions

Breast lesions (abnormalities in breast tissue) that are not cancer may need to be surgically removed depending on various factors. Some lesions need to be removed for more evaluation, to prevent growth, or to prevent them from developing into breast cancer. There are many types of benign (non-cancerous) breast conditions that we may treat with surgery, including:

  • Complex cysts (cysts filled with something besides clear fluid)
  • Benign breast lumps (fibroadenoma and hamartoma)
  • Build-up of abnormal cells in the breast (atypical ductal hyperplasia)
  • Hardening of the breast tissue (radial scars or complex sclerosing lesions)
  • Benign growths (fibroepithelial lesions)
  • Flat epithelial atypia
  • Benign tumors of the breast or milk duct (phyllodes tumors, intraductal papilloma)
  • Radial scar
  • Depending on the size and position of the growth, your surgeon may recommend a wire localization or radioactive seed localization to determine its exact location.

If you have been diagnosed with breast cancer, surgery will probably be a part of your care plan. There are many types of breast surgery in cancer treatment. You and your breast surgeon will determine the best option for you, based on your diagnosis and your goals.

The right surgery for you will depend on many factors: the size and location of your cancer, how advanced your cancer is, whether the cancer has spread, and whether genetic testing indicates BRCA1 or BRCA2 or other genetic mutations.

In general, surgeries for breast cancer fall into two categories:

  • Breast-conserving surgery, where only the cancer and surrounding tissue are removed. Examples of this type of surgery include a lumpectomy, partial mastectomy, or segmented mastectomy.
  • Mastectomy, where all of the breast tissue is removed as well as tissue from surrounding areas. This procedure is also called a radical or total mastectomy. In recent years, skin sparing and nipple sparing mastectomies have also become options.
Radioactive Seed Localization (RSL)
Radioactive seed localization (RSL) is an option if you need surgery to remove a tumor that cannot be identified with a physical exam or ultrasound.

During RSL, a radiologist places a very low-energy radioactive seed (pellet) into the abnormal tissue or tumor in your breast. Often a mammogram technician helps guide the placement of the implant.

This procedure is an outpatient, minimally invasive surgery, which generally means faster healing and less chance of complications. In addition, studies show that RSL reduces the need to have a second surgery due to incomplete removal of the abnormal tissue.
Nipple Sparing Mastectomy (NSM)
Nipple sparing mastectomy (NSM) is an option in certain cases, depending on the size and shape of your breast as well as the location of the cancer.

During this procedure, breast tissue is removed from under your skin through an incision. Your nipple is left intact. The surgery is typically performed by a surgical oncologist and a plastic surgeon — and is therefore known as a type of “oncoplastic” surgery.

Working together, the surgeons remove the necessary amount of tissue to help prevent future cancer, while maintaining the best possible cosmetic result. The plastic surgeon may place a breast implant during the surgery.
Lymph Node Removal
Breast cancer that spreads typically reaches the lymph nodes (small, bean-shaped glands under your arms) first. A sentinel lymph node is the first lymph node to which breast cancer cells are likely to spread.

During your surgery, your doctor will inject a dye to find any unusual nodes under your arm. Any unusual node will be removed and looked at under the microscope (a sentinel lymph node biopsy). If more than one node is involved, the nodes under your arm may need to be removed. This is called an axillary lymph node dissection (ALND).

The sentinel nodes will be removed during surgery. Next they will be evaluated by the lab to see if the cancer has spread to the lymph nodes. If your sentinel nodes do not have cancer in them, then you do not need to worry about spread to any of the other lymph nodes under the arm. If we do find cancer in the sentinel nodes, we will recommend medical therapy and radiation therapy specific to your situation.
Breast-Conserving Surgery
You may be a candidate for breast-conserving surgery such as a lumpectomy or a partial mastectomy if you have been diagnosed with an early-stage cancer.

This kind of breast surgery allows you to keep much of your breast. The type and extent of surgery is based on the size of your breast, the size of the mass and the type of cancer. Your surgeon will describe the options that will work best for you and involve you in the treatment decision.

A breast-conserving surgery treatment plan often incorporates radiation treatments to help prevent the cancer from coming back. The decision about radiation is based on many factors including age, size of cancer, as well as the type and aggressiveness of the cancer.

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