Introduction
Step 1: Talk with your surgeon
Step 2: Learn the facts
Step 3. Find out about your breast cancer surgery choices
Step 4: Compare your choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 4: Compare Your Choices
Step 5: Think about what is important to you
Step 6: Make your choice
Resources to Learn More
Introduction
As a woman with
early-stage breast cancer
(DCIS or Stage I, IIA, IIB, or IIIA breast
cancer) you may be able to choose which type
of breast surgery to have. Often, your choice is between
breast-sparing surgery
(surgery that takes out the cancer
and leaves most of the breast) and a
mastectomy
(surgery that removes the whole breast). Research shows
that women with early-stage breast cancer who have
breast-sparing surgery along with
radiation therapy
live
as long as those who have a mastectomy. Most women
with breast cancer will lead long, healthy lives after
treatment.
Treatment for breast cancer usually begins a few weeks
after diagnosis. In these weeks, you should meet with a
surgeon, learn the facts about your surgery choices, and
think about what is important to you. Then choose
which kind of surgery to have.
Most women want to make this choice. After all, the kind
of surgery you have will affect how you look and feel. But
it is often hard to decide what to do. This booklet has
information that can help you make a choice you feel
good about.
This booklet is for women who have early-stage breast
cancer (DCIS or Stage I, IIA, IIB, or IIIA). If your cancer
is Stage IIIB, IIIC, or IV this booklet does not have the
information you need. To find information for you, see
"Resources to Learn More."
Of note, important words are in bold and defined
through this booklet.
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Step 1: Talk with your surgeon
Talk to a surgeon about your breast cancer surgery choices.
Find out what happens during surgery, types of problems that
sometimes occur, and other kinds of treatment (if any) you will
need after surgery. Be sure to ask a lot of questions and learn as
much as you can. You may also wish to talk with family
members, friends, or others who have had breast cancer surgery.
After talking with a surgeon, you may want a second opinion.
This means talking with another doctor who might tell you
about other treatment options or simply give you information
that can help you feel better about the choice you are making.
Don't worry about hurting your surgeon's feelings. It is common
practice to get a second opinion and some insurance companies
require it. Plus, it is better to get a second opinion than worry
that you made the wrong choice.
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Step 2: Learn the facts
Doctors talk about
stages
of cancer. This is a way of saying how big the tumor
is and how far it has spread. If you are unsure of the stage of your cancer,
ask your doctor or nurse. Here are the stages of breast cancer discussed in
this book:
-
Stage 0: This means that you either have DCIS or
LCIS.
-
DCIS (Ductal Carcinoma In Situ) is very early breast cancer that is often too
small to form a lump. Your doctor may refer to DCIS as
noninvasive cancer.
-
LCIS (Lobular Carcinoma In Situ) is not cancer but may increase the chance that
you will get breast cancer. Talk with your doctor about treatment options if
you are diagnosed with LCIS.
-
Stage I: Your cancer is less than 1 inch across (2 centimeters) or about
the size of a quarter. The cancer is only in the breast and has not spread to
lymph nodes or other parts of your body.
-
Stage IIA:
-
No cancer is found in your breast, but cancer is found in the lymph nodes under
your arm; or
-
Your cancer is 1 inch (2 centimeters) or smaller and has spread to the lymph
nodes under your arm; or
-
Your cancer is about 1 to 2 inches (2 to 5 centimeters) but has not spread to
the lymph nodes under your arm.
-
Stage IIB:
-
Your cancer is about 1 to 2 inches (2 to 5 centimeters) and has spread to the
lymph nodes under your arm; or
-
Your cancer is larger than 2 inches (5 centimeters) and has not spread to the
lymph nodes under your arm.
-
Stage IIIA:
-
No cancer is found in the breast, but is found in lymph nodes under your arm,
and the lymph nodes are attached to each other; or
-
Your cancer is 2 inches (5 centimeters) or smaller and has spread to lymph
nodes under your arm, and the lymph nodes are attached to each other; or
-
Your cancer is larger than 2 inches (5 centimeters) and has spread to lymph
nodes under your arm.
Lymph nodes are part of your body's immune system which helps fight infection
and disease. Lymph nodes are small, round, and clustered (like a bunch of
grapes) throughout your body.
Axillary lymph nodes are in the area under your arm. Breast cancer may spread
to these lymph nodes even when the tumor in the breast is small. This is why
most surgeons take out some of these lymph nodes.
Lymphedema
is a swelling caused by a buildup of
lymph
fluid. You may have this
type of swelling in your arm if your lymph nodes are taken out with surgery or
damaged by radiation therapy. Here are some facts to know:
-
Lymphedema can show up soon after surgery. The symptoms are often mild and last
for a short time.
-
Lymphedema can show up months or even years after cancer treatment is over.
Often, lymphedema develops after an insect bite, minor injury, or burn on the
arm where your lymph nodes were removed. Sometimes, this can be painful. One
way to reduce the swelling is to work with a doctor who specializes in
rehabilitation or a physical therapist.
Sentinel lymph node biopsy
is surgery to remove as few lymph nodes as possible
from under the arm. The surgeon first injects a dye in the breast to see which
lymph nodes the breast tumor drains into. Then, he or she removes these nodes
to see if they have any cancer. If there is no cancer, the surgeon may leave
the other lymph nodes in place. This surgery is new and is under study in
clinical trial
(research studies with people who have cancer). Talk with your
surgeon if you want to learn more.
For ways to find out more about lymphedema, look in "Resources to Learn More."
|
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Step 3. Find out about your breast cancer surgery choices
Most women who have DCIS or Stage I, IIA, IIB, or
IIIA breast cancer have three basic surgery choices. They are
1) breast-sparing surgery followed by radiation therapy,
2) mastectomy, or 3) mastectomy with breast reconstruction
surgery.
Breast-sparing surgery means that the surgeon removes only
your cancer and some normal tissue around it. This kind of
surgery keeps your breast intact--looking a lot like it did before
surgery. Other words for breast-sparing surgery include
"lumpectomy," "partial mastectomy," "breast-conserving
surgery," or "segmental mastectomy."
After breast-sparing surgery, most women also get radiation
therapy. This type of treatment is very important because it
could keep cancer from coming back in the same breast. Some
women also need
chemotherapy
and
hormone therapy.
In a mastectomy, the surgeon removes all of your breast and
nipple. Sometimes, you will also need to have radiation therapy,
chemotherapy, hormone therapy, or all three types of therapy.
Here are some types of mastectomy:
- Total (simple) mastectomy. The surgeon removes all of
your breast. Sometimes, the surgeon also takes out some of
the lymph nodes under your arm.
- Modified radical mastectomy. The surgeon removes all of
your breast, many of the lymph nodes under your arm, the
lining over your chest muscles, and maybe a small chest
muscle.
- Double Mastectomy. The surgeon removes both your
breasts at the same time, even if your cancer is in only one
breast. This surgery is rare and mostly used when the
surgeon feels you have a high risk for getting cancer in the
breast that does not have cancer.
If you have a mastectomy, you can also choose to have breast
reconstruction surgery. This surgery is done by a
reconstructive plastic surgeon
and gives you a new breast-like shape and
nipple. Your surgeon can also add a tattoo that looks like the
areola
(the dark area around your nipple). Or you may not want
any more surgery and prefer to wear a
prosthesis
(breast-like
form) in your bra. There are two types of breast reconstruction
surgery:
- Breast implants. In this kind of surgery, a reconstructive
plastic surgeon puts an
implant
(filled with salt water or
silicone gel) under your skin or chest muscle to build a new
breast-like shape. While this shape looks like a breast, you
will have little feeling in it because the nerves have been cut.
Breast implants do not last a lifetime. If you choose to have
an implant, chances are you will need more surgery later on
to remove or replace it. Implants can cause problems such as
breast hardness, breast pain, and infection. The implant may
also break, move, or shift. These problems can happen soon
after surgery or years later.
- Tissue flaps. In
tissue flap surgery, a surgeon builds a new
breast-like shape from muscle, fat, and skin taken from other
parts of your body. This new breast-like shape should last the
rest of your life.Women who are very thin or obese, smoke,
or have other serious health problems often cannot have
tissue flap surgery.
Tissue flap is major surgery. Healing often takes longer after
this surgery than if you have breast implants. You may have
other problems, as well. For example, you might lose
strength in the part of your body where muscle was taken to
build a new breast. Or you may get an infection or have
trouble healing. Tissue flap surgery is best done by a
reconstructive plastic surgeon who has done it many times
before.
To learn more about breast reconstruction, see "Resources to
Learn More."
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Step 4: Compare your choices
Below are some questions you may be thinking about. Click on the question to learn more.
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
Breast-sparing surgery with radiation is a safe choice for most
women who have early-stage breast cancer.This means that your cancer is DCIS or
at Stage I, IIA, IIB, or IIIA. |
Mastectomy is a safe choice for women who have early-stage breast
cancer (DCIS, Stage I, IIA, IIB, or IIIA). You may need a mastectomy if:
-
You have small breasts and a large tumor
-
You have cancer in more than one part of your breast
-
The tumor is under the nipple
-
You do not have access to radiation therapy.
|
If you have a mastectomy, you might also want breast
reconstruction surgery.
You can choose to have reconstruction surgery at the same time as your
mastectomy or wait and have it at a later date.
|
Back to Questions List
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
-
Lumpectomy
-
Partial mastectomy
-
Breast-sparing surgery
-
Segmental mastectomy
|
-
Total mastectomy
-
Modified radical mastectomy
-
Double mastectomy
|
-
Breast implant
-
Tissue flap surgery
|
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
-
Oncologist
-
Surgeon
-
Radiation oncologist
|
-
Oncologist
-
Surgeon
-
Radiation oncologist
|
-
Oncologist
-
Surgeon
-
Radiation oncologist
-
Reconstructive plastic surgeon
|
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
Your breast should look a lot like it did before surgery.
But if your tumor is large, your breast may look different or smaller after
breast-sparing surgery.
|
Your breast and nipple will be removed.You will have a flat chest
on the side of your body where the breast was removed. |
Although you will have a breast-like shape, your breast will not
look the same as it did before surgery. |
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
Yes. You should still have feeling in your breast, nipple, and
areola (the dark area around your nipple). |
Maybe. After surgery, you will feel numb (have no feeling) in your
chest wall and maybe also under your arm.
This numb feeling should go away in 1 to 2 years, but it will never feel like it
used to. Also, the skin where your breast was may feel tight.
|
No. The area around your breast will always be numb (have no
feeling). |
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
You may have pain after surgery.
Talk with your surgeon or nurse about ways to control this pain.
To find out ways to learn more about pain control, see "Resources
to Learn More."
|
You may have pain after surgery. Talk with your surgeon or nurse
about ways to control this pain.
To find out ways to learn more about pain control, see "Resources
to Learn More."
|
You are likely to have pain after major surgery such as mastectomy
and reconstruction surgery.
There are many ways to deal with pain. Let your surgeon or nurse know if you
need relief from pain. To find out ways to learn more about pain control, see "Resources
to Learn More."
|
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
-
You may feel very tired after radiation therapy.
-
You may get lymphedema-- a problem in which your arm swells.To find out more
about lymphedema, see the "About
Lymph Nodes" box and "Resources
to Learn More."
|
-
You may have pain in your neck or back.
-
You may feel out of balance if you had large breasts and do not have
reconstruction surgery.
-
You may get lymphedema-- a problem in which your arm swells.To find out more
about lymphedema, see the "About
Lymph Nodes" box and "Resources
to Learn More."
|
-
It may take you many weeks or even months to recover from breast reconstruction
surgery.
-
If you have an implant, you may get infections, pain, or hardness. Also, you
may not like how your breast-like shape looks.You may need more surgery if your
implant breaks or leaks.
-
If you have tissue flap surgery, you may lose strength in the part of your body
where the flap came from.
-
You may get lymphedema-- a problem in which your arm swells.To find out more
about lymphedema, see the "About
Lymph Nodes" box and "Resources
to Learn More."
|
Back to Questions List
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
Maybe.You may need more surgery to remove lymph nodes from under
your arm. Also, if the surgeon does not remove all your cancer the first time,
you may need more surgery.
|
Maybe.You may need surgery to remove lymph nodes from under your
arm. Also, if you have problems after your mastectomy, you may need to see your
surgeon for treatment. |
Yes.You will need surgery at least 2 more times to build a new
breast-like shape.With implants, you may need more surgery months or years
later.You may also need surgery to remove lymph nodes from under your arm. |
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
You will need radiation therapy, given almost every day for 5 to 8
weeks.You also may need chemotherapy, hormone therapy, or both. |
You also may need chemotherapy, hormone therapy, or radiation
therapy. Some women get all three types of therapy. |
You may need chemotherapy, hormone therapy, or radiation therapy.
Some women get all three types of therapy. |
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
Check with your insurance company to find out how much it pays for
breast cancer surgery and other needed treatments. |
Check with your insurance company to find out how much it pays for
breast cancer surgery and other needed treatments. |
Check with your insurance company to find out if it pays for
breast reconstruction surgery. You should also ask if your insurance will pay
for problems that may result from breast reconstruction surgery. |
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
Women with early-stage breast cancer who have breast-sparing
surgery followed by radiation live just as long as women who have a
mastectomy.Most women with breast cancer will lead long, healthy lives after
treatment. |
Women with early-stage breast cancer who have a mastectomy live
the same amount of time as women who have breast-sparing surgery followed by
radiation therapy.Most women with breast cancer will lead long, healthy lives
after treatment. |
Women with early-stage breast cancer who have a mastectomy live
the same amount of time as women who have breast-sparing surgery followed by
radiation therapy.Most women with breast cancer will lead long, healthy lives
after treatment. |
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Step 4: Compare Your Choices
Breast-Sparing Surgery |
Mastectomy Surgery |
Mastectomy and Breast Reconstruction Surgery |
About 10% (1 out of every 10) of women who have breast-sparing
surgery along with radiation therapy get cancer in the same breast within 12
years. If this happens, you will need a mastectomy, but it will not affect how
long you live. |
About 5% (1 out of every 20) of women who have a mastectomy will
get cancer on the same side of their chest within 12 years. |
About 5% (1 out of every 20) of women who have a mastectomy will
get cancer on the same side of their chest within 12 years. Breast
reconstruction surgery does not affect the chances of your cancer coming back. |
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Step 4: Compare Your Choices
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Step 5: Think about what is important to you
After you have talked with your surgeon and learned the facts,
you may also want to talk with your spouse or partner, family,
friends, or other women who have had breast cancer surgery.
Then, think about what is important to you. Here are some
questions to think about:
- Do I want to get a second opinion?
- How important is it to me how my breast looks after cancer
surgery?
- How important is it to me how my breast feels after cancer
surgery?
- If I have breast-sparing surgery, am I willing and able to also
get radiation therapy?
- If I have a mastectomy, do I also want breast reconstruction
surgery?
- If I have breast reconstruction surgery, do I want it at the
same time as my mastectomy?
- What treatment does my insurance cover, and what do I have
to pay for?
- Who would I like to talk with about my surgery choices?
- What else do I want to know, do, or learn before I make my
choice about breast cancer surgery?
"After I learned all I could and talked with my surgeon,
I made a choice that felt right for me." |
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Step 6: Make your choice
Now that you have talked with your surgeon, learned the facts,
and thought about what is important to you--it's time to make
your breast cancer surgery choice.
"Now that my surgery is over, I don't look back.
I enjoy each day and take time for the simple pleasures." |
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Resources to Learn More
National Cancer Institute
-
Cancer Information Service
Gives up-to-date information on cancer to patients and their
families, health professionals, and the general public.
Information specialists explain scientific information in
plain language and respond in English or Spanish.
www.cancer.gov
The National Cancer Institute's Web site contains
information about cancer causes and prevention, screening
and diagnosis, treatment, symptom management, and
survivorship; clinical trials; statistics, funding, and training;
and the NCI's programs and research activities.
National Research Center for Women & Families
Provides information, such as questions to ask your doctor
and treatment options; geographic, financial, and personal
issues influencing breast cancer surgery; and advantages and
risks of breast reconstruction surgery.
Office on Women's Health
National Women's Health Information Center
Provides information about breast cancer, including
questions to ask your doctor.
Agency for Healthcare Research and Quality (AHRQ)
Provides information on breast cancer screening and
prevention.
National Lymphedema Network
Provides education and guidance to lymphedema patients,
health care professionals, and the general public by
disseminating information on the prevention and
management of primary and secondary lymphedema.
American Cancer Society
Phone: | | 404-320-3333 |
Toll-free: | | 1-800-227-2345 (I-800-ACS-2345) |
Web site: | | www.cancer.org |
National Library of Medicine
U.S. Food and Drug Administration
National Cancer Institute
- Cancer Information Service
Gives up-to-date information on cancer to patients and their
families, health professionals, and the general public.
Information specialists explain scientific information in
plain language and respond in English or Spanish.
-
www.cancer.gov
The National Cancer Institute's Web site contains
information about cancer causes and prevention, screening
and diagnosis, treatment, symptom management, and
survivorship; clinical trials; statistics, funding, and training;
and the NCI's programs and research activities.
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|