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 ¹."

Of note, important words are in bold and defined through this booklet.

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.

Stages of Breast Cancer

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.

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

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.

Mastectomy

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.

Breast Reconstruction Surgery

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 ¹."

Below are some questions you may be thinking about. Click on the question to learn more.

1. Is this surgery right for me?

Back to Questions List ¹⁴

2. What are the names of the different kinds of surgery?

Back to Questions List ¹⁴

3. What doctors am I likely to see?

Back to Questions List ¹⁴

4. What will my breast look like after surgery?

Back to Questions List ¹⁴

5. Will I have feeling in the area around my breast?

Back to Questions List ¹⁴

6. Will I have pain after the surgery?

Back to Questions List ¹⁴

7. What other problems can I expect?

Back to Questions List ¹⁴

8. Will I need more surgery?

Back to Questions List ¹⁴

9. What other types of treatment will I need?

Back to Questions List ¹⁴

10. Will insurance pay for my surgery?

Back to Questions List ¹⁴

11. Will the type of surgery I have affect how long I live?

Back to Questions List ¹⁴

12. What are the chances that my cancer will come back after surgery?

Back to Questions List ¹⁴

13. Where can I learn more about coping with life after cancer?

Back to Questions List ¹⁴

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?

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• How important is it to me how my breast looks after cancer surgery?

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• How important is it to me how my breast feels after cancer surgery?

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• If I have breast-sparing surgery, am I willing and able to also get radiation therapy?

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• If I have a mastectomy, do I also want breast reconstruction surgery?

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• If I have breast reconstruction surgery, do I want it at the same time as my mastectomy?

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• What treatment does my insurance cover, and what do I have to pay for?

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• Who would I like to talk with about my surgery choices?

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• What else do I want to know, do, or learn before I make my choice about breast cancer surgery?

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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.

Learn More About Breast Cancer

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.

  Toll-free:		1-800-4-CANCER (1-800-422-6237)
  TTY:		1-800-332-8615
  Chat online:		www.cancer.gov click on "Need Help? 17" then "LiveHelp 18"

• 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.

Web site:

www.center4research.org

Office on Women's Health

National Women's Health Information Center
Provides information about breast cancer, including questions to ask your doctor.

Web site:

www.4women.gov

Agency for Healthcare Research and Quality (AHRQ)

Provides information on breast cancer screening and prevention.

Web site:

www.ahrq.gov/clinic

Learn More About Lymphedema

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.

Phone:		510-208-3200
Toll-free:		1-800-541-3259
E-mail:		nln@lymphnet.org
Web site:		www.lymphnet.org

Learn More About Breast Reconstruction Surgery and Implants

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

Resources about breast reconstruction.
www.nlm.nih.gov/medlineplus/breastreconstruction.html

U.S. Food and Drug Administration

Center for Devices and Radiological Health
Information about breast implants.
www.fda.gov/cdrh/breastimplants

Learn More About Pain Control

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.

  Toll-free:		1-800-4-CANCER (1-800-422-6237)
  TTY:		1-800-332-8615
  Chat online:		www.cancer.gov click on "Need Help? 17" then "LiveHelp 18"

• 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.

Glossary Terms

The area of dark-colored skin on the breast that surrounds the nipple.

An operation to remove the breast cancer but not the breast itself. Types of breast-sparing surgery include lumpectomy (removal of the lump), quadrantectomy (removal of one quarter, or quadrant, of the breast), and segmental mastectomy (removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor). Also called breast-conserving surgery.

Treatment with drugs that kill cancer cells.

A type of research study that tests how well new medical approaches work in people. These studies test new methods of screening, prevention, diagnosis, or treatment of a disease. Also called clinical study.

A noninvasive condition in which abnormal cells are found in the lining of a breast duct. The abnormal cells have not spread outside the duct to other tissues in the breast. In some cases, DCIS may become invasive cancer and spread to other tissues, although it is not known at this time how to predict which lesions will become invasive. Also called ductal carcinoma in situ and intraductal carcinoma.

Treatment that adds, blocks, or removes hormones. For certain conditions (such as diabetes or menopause), hormones are given to adjust low hormone levels. To slow or stop the growth of certain cancers (such as prostate and breast cancer), synthetic hormones or other drugs may be given to block the body’s natural hormones. Sometimes surgery is needed to remove the gland that makes a certain hormone. Also called endocrine therapy, hormonal therapy, and hormone treatment.

A substance or object that is put in the body as a prosthesis, or for treatment or diagnosis.

A condition in which abnormal cells are found in the lobules of the breast. LCIS seldom becomes invasive cancer; however, having it in one breast increases the risk of developing breast cancer in either breast. Also called lobular carcinoma in situ.

Surgery to remove abnormal tissue or cancer from the breast and a small amount of normal tissue around it. It is a type of breast-sparing surgery.

The clear fluid that travels through the lymphatic system and carries cells that help fight infections and other diseases. Also called lymphatic fluid.

A rounded mass of lymphatic tissue that is surrounded by a capsule of connective tissue. Lymph nodes filter lymph (lymphatic fluid), and they store lymphocytes (white blood cells). They are located along lymphatic vessels. Also called lymph gland.

Surgery to remove the breast (or as much of the breast tissue as possible).

A device, such as an artificial leg, that replaces a part of the body.

The use of high-energy radiation from x-rays, gamma rays, neutrons, protons, and other sources to kill cancer cells and shrink tumors. Radiation may come from a machine outside the body (external-beam radiation therapy), or it may come from radioactive material placed in the body near cancer cells (internal radiation therapy). Systemic radiation therapy uses a radioactive substance, such as a radiolabeled monoclonal antibody, that travels in the blood to tissues throughout the body. Also called irradiation and radiotherapy.

A doctor who can surgically reshape or rebuild (reconstruct) a part of the body, such as a woman's breast after surgery for breast cancer.

The extent of a cancer in the body. Staging is usually based on the size of the tumor, whether lymph nodes contain cancer, and whether the cancer has spread from the original site to other parts of the body.

A type of breast reconstruction in which a flap of tissue is surgically moved from another area of the body to the chest, and formed into a new breast mound.