Breast Surgery

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Benign Breast Disease

1. Breast Tumors
2. Breast Cysts
3. Breast Pain
4. Nipple Discharge with Major Duct Excision

Malignant Breast Disease

1. Sentinel Lymph Node Biopsy
2. Partial Mastectomy
3. Mastectomy
4. Nipple Sparing Mastectomy with Immediate Reconstruction
5. Skin Sparing Mastectomy with Immediate Reconstruction
6. Pregnancy-Associated Breast Cancer
7. Surgery Following Neoadjuvant Chemotherapy
8. Male Breast Cancer 

*Benign Breast Disease 

Breast Tumors - Many women who feel a new lump in the breast have benign breast tumors as opposed to invasive breast cancer. A needle biopsy may give the diagnosis and no further procedure is required. Sometimes surgical removal of the lump is necessary to rule out the presence of cancer. Excision is performed in the operating room and patients are discharged home the same day.

Breast Cysts - Many women will have a breast cyst during their lifetime. Usually diagnosed by ultrasound, breast cysts are most often benign and require no intervention. They may be managed with simple aspiration and follow-up imaging if infected or symptomatic. In some cases, excisional biopsy is indicated for recurrent cysts to rule out malignancy.

Breast Pain (Mastodynia) - The vast majority of breast pain can be effectively treated by lifestyle modification. When pain is persistent and severe, some medications are available for management of ongoing symptoms. Most often breast pain is cyclical and is caused by hormones.

Nipple Discharge with Major Duct Excision - Nipple discharge can occur in non-lactating women and often requires no treatment. When spontaneous bloody or clear discharge is present or a mass is identified in the duct, surgical excision of this duct can be performed through a small incision on the breast. This procedure usually eliminates further drainage from the nipple and ensures that no cancer is present.

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*Malignant Breast Disease

Sentinel Lymph Node Biopsy - This procedure is for staging of the cancer. Some patients with breast cancer may not require removal of all lymph nodes from the armpit. The sentinel  node is the first lymph node to receive lymphatic drainage from the tumor. Using an injection of blue dye and a radioactive tracer to help find the sentinel lymph node, surgeons can remove the lymph node to determine possible spread of cancer cells. This is performed through a separate incision under the arm and allows some patients to avoid removal of additional axillary nodes. If the sentinel lymph node is positive for tumor cells, additional lymph nodes under the arm should be removed. 

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Partial Mastectomy - Patients with early stage breast cancer may be candidates for breast conservation therapy or partial mastectomy. This treatment involves removal of the tumor with a rim of normal tissue around it known as the margins. This is often performed in conjunction with a sentinel lymph node biopsy.

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Mastectomy - In the case of larger breast tumors or multicentric disease (multiple tumors in different areas of the breast) patients require one of the following treatments:

*Total Mastectomy involves removal of the entire breast including the nipple and areolar complex.

*Modified Radical Mastectomy includes removal of the entire breast including the nipple and areolar complex and most of the lymph nodes from the armpit (level I,II).

*Radical Mastectomy involves removal of the entire breast including the nipple and areolar complex, lymph nodes, and chest wall muscles.

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Nipple Sparing Mastectomy with Immediate Reconstruction - Some patients undergoing skin sparing mastectomy may be eligible for a Nipple Sparing Mastectomy.  The surgeon performs a biopsy behind the nipple to see if the patient is a candidate during the operation. This operation removes the breast tissue but leaves the outer skin, nipple and areolar complex. Plastic surgeons then perform the reconstruction during the same operation.

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Skin Sparing Mastectomy with Immediate Reconstruction - When patients are diagnosed with breast cancer and choose to have mastectomy, removal of all breast tissue including the nipple/areola complex with skin preservation may be an option. The tumor must not involve the skin. Plastic surgeons can then perform breast reconstruction during the same operation.

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 Pregnancy-Associated Breast Cancer - Pregnancy-Associated Breast Cancer (PABC) is generally defined as cancer diagnosed during pregnancy, up to one year after delivery, or at any time while the patient is lactating. Pregnant patients with early stage breast tumors may still be candidates for breast conservation with delay of radiation therapy until after delivery. Some patients may require a mastectomy. Others may require chemotherapy prior to any surgery. Patients may discuss personal treatment options with their surgeon.

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 Surgery Following Neoadjuvant Chemotherapy - Many patients with advanced stage breast cancer may benefit from initial treatment with chemotherapy before surgery. This approach often shrinks the tumor, allowing subsequent partial mastectomy and preservation of the breast. It can also help make unresectable tumors resectable if they are large, fixed to the chest wall, or otherwise locally advanced.

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 Male Breast Cancer - Breast cancer in men affects less than 1000 patients each year in the United States. Patients with BRCA1 or BRCA2 mutation, history of chest irradiation, cirrhosis, Kleinfelter's syndrome, or history of estrogen use may be at increased risk. Treatment begins with surgery and may be followed by radiation, chemotherapy, and hormonal therapy. Most patients require total mastectomy with sentinel lymph node biopsy and possible complete removal of axillary lymph nodes. Prognosis is similar to that of women diagnosed with breast cancer. 

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