Breast cancer treatment videos

Lumpectomy or mastectomy

In this video we cover what happens during a breast lumpectomy and mastectomy. We'll also look at when each option is most appropriate. 

[MUSIC PLAYING] The first option oftentimes is a lumpectomy. If it's not something I can feel, then I'll have to do some localization procedure before the surgery so I know where to go in the breast. Usually, here we use a radioactive seed. So I put a little bead into the breast right where the cancer is, and then I can find it using a Geiger counter. Then the patient is taken to the operating room, an incision would be made over either the lump that's palpable or where that radioactive bead or wire is.

And then my goal is to get the cancer out with normal breast tissue all the way around it. So what we do here is we put ink around the periphery of that lumpectomy. It goes to the lab, and they will try to assess it during the operation. But in fact, the best look at those edges or the margins happens two days later. So with a lumpectomy, there is a chance a person might need a second operation to get a clear margin, because we couldn't assess that thoroughly at the time of their operation.

So the alternative to a lumpectomy would be a mastectomy. And with that, the entire breast is removed. Whether you can save your nipple or not will depend on the contour of your breast, where the cancer is located, how big the cancer is, and if you're going to undergo reconstruction at all.

And with a mastectomy, you usually don't need subsequent radiation. But in fact, there are reasons to radiate post-mastectomy. So that final decision is made after we see the pathology that we get 48 hours after the surgery.

With a mastectomy, you'd have the option of reconstruction. And so I do introduce what those operative options are. And I will go over them and show some pictures. And if a patient wants to pursue that, then I'll get them in to see a plastic surgeon to further that discussion. And reconstruction can be started usually at the time of surgery, or it can be done on a delayed basis. So ultimately, it's up to the patient how they want to proceed with that.

Sentinel node

[MUSIC PLAYING] So when cancer is in the breast and it's going to metastasize or go somewhere else, it travels, typically, through the lymphatic channels to the nodes in the armpit. And it goes to one node first. We call it one, but sometimes there's two. I think the average here is 1.7.

But it drops off tumor cells there. And then it will potentially spread to other nodes. But if we can find that very first node, called the sentinel node, and we can see that there's no cancer in there, then it's very likely there's no cancer anywhere else downstream or upstream from that.

So if we find the sentinel node and we take that out and there's no cancer in it, we can leave the rest of the nodes behind. And then it will reduce the risk of complications in the arm—lymphedema and range of motion things and pain. So that's why we look for the sentinel node.