Breast Cancer:
Understanding Treatment and Options (3)

AXILLARY NODE DISSECTION
Axillary node dissection refers to the staging procedure performed in conjunction with lumpectomy for breast conservation or mastectomy. The procedure involves an axillary incision below the hairline when performed with a lumpectomy and is performed through the mastectomy incision with removal of the breast.

Removal of level I and Ii lymph nodes includes the tissue between the axillary portion of the breast and the area above the axillary vein underlying the pectoral major muscle are preserved to decrease the incidence of arm edema. It may also remove a small nerve in the process resulting in numbness to the posterior aspect of the arm. Determining whether the lymph nodes are involved with the tumor will stage the cancer to determine if chemotherapy will be needed.

A WORD ABOUT BREAST RECONSTRUCTION
As you consider mastectomy as a treatment option, you should be aware of breast reconstruction, a way to recreate the breast’s shape after a natural breast has been removed.

Today, almost any woman who has had a mastectomy can have her breast reconstructed. Successful reconstruction is no longer hampered by radiation-damaged, thin skin, tight skin, or the absence of chest wall muscles. The options for immediate reconstruction after mastectomy will be discussed with your surgeon and again when you consult with a plastic and reconstructive surgeon.

Reconstruction is not for everyone and may not be right for you. After mastectomy, many women prefer to wear artificial breast forms or prostheses inside their surgical bras. Both a general surgeon and a plastic surgeon may help you decide whether to have breast reconstruction.

You should discuss breast reconstruction before your surgery because the position of the incision may affect the reconstruction procedure. A procedure called a skin-sparing mastectomy has been able to greatly enhance the final reconstruction results and should also be discussed with your surgeon prior to the operation.

Having breast reconstruction at the time of your cancer surgery can lead to better cosmetic results, decreased risks from additional anesthesia and added psychological benefits to you. All of these benefits can result from immediate reconstruction, without compromising the curative aspects of your cancer operation.

RADIATION THERAPY
Radiation therapy as a primary treatment is a promising technique for women who have early stage breast cancer. This procedure allows a woman to keep her breast and involves lumpectomy followed by radiation (x-ray) treatment. Once a biopsy has been done and breast cancer has been diagnosed, radiation treatment usually involves the following steps.
Surgery to evaluate underarm lymph nodes to see if the cancer has spread beyond the breast, (i.e. sentinel lymph node biopsy or axillary lymph node dissection.)

External radiation therapy to the breast and the surrounding area (involving approximately five weeks of treatment).

"Boost” radiation therapy to the biopsy site which is usually marked with surgical clips to mark the tumor bed (one additional week of radiation therapy).

For external radiation therapy, a machine beams x-rays to the breast and possibly the underarm lymph nodes. The usual schedule for radiation therapy is 5 days a week for about 5-7 weeks. In some instances, a “boost” or concentrated dose of radiation may be given to the area where the cancer was located. This can be done with an electron beam. Less frequently used is a boost done internally with an implant of radioactive materials.

ADVANTAGES
The breast is not removed. Lumpectomy with radiation therapy as a primary treatment for breast cancer appears to be as effective as mastectomy for treating early stage breast cancer. Usually there is not much deformity of the surrounding tissues. This skin usually regains a normal appearance.

DISADVANTAGES
A full course of treatment requires short daily visits to the hospital as an outpatient for approximately 5 weeks. Treatment may produce a skin reaction like sunburn, and may cause tiredness. Itching or peeling of the skin may also occur. Radiation therapy can sometimes cause a temporary decrease in white blood cell count, which may increase the risk of infection. You maintain your breast and, therefore, have a variable risk of local recurrence which would necessitate mastectomy should cancer return. Post-mastectomy reconstruction options are limited after radiation therapy to the breast.