Surgery gynecology and senology

Axillary dissection

If tumor cells are found in a sentinel lymph node, in some cases it makes sense to remove other lymph nodes in a second operation. State-of-the-art is the surgical removal of at least 10 lymph nodes of level I and II. Side effects of axillary dissection can be numbness, restricted motion and swellings (lymphedema).

Breast-conserving surgery

It is possible to perform a breast-conserving surgery in most cases. Goal of the breast-conserving surgery is the complete removal of the breast cancer with a resection margin (edge between cancerous and healthy tissue) without any cancerous cells. The minimal distance between healthy and cancerous tissue is 1 mm (0.04 in.) in case of invasive breast cancer and 2 mm (0.08 in.) in case of the ductal carcinoma in situ (DCIS).

In order to prevent a deformed breast, the hole created by the removal of cancerous tissue is filled by healthy tissue being shifted towards the hole. Generally, a drainage is installed so that blood and ichor can drain off. Complications after breast-conserving surgery are rare. It is important to keep in mind that if the tissue of the resection margin is tumor positive, another surgery is necessary. After breast-conserving surgery, patients have to undergo radiation therapy.

Mastectomy

Mastectomy is the removal of one or both breasts. We differentiate between the modified radical mastectomy (MRM) and the skin sparing mastectomy (SSM). During radical mastectomy, the whole breast including adjacent skin and surface layers of the pectoral fascia are removed. In case of skin sparing mastectomy, the breast tissue is completely extracted, but the skin and nipple remain.

When is mastectomy indicated?

Mastectomy is indicated if performing the breast-conserving surgery is not possible due to the following reasons:

  • two or more cancerous areas in the breast
  • tumor larger than 4 cm (1.6 in)
  • resection margin is tumor positive despite several operations
  • inflammation
  • radiation is not possible
  • at patient´s request

Breast reconstruction

Breast reconstruction within the scope of mastectomy is possible immediately or later by using implants, own tissue flaps from your belly or buttocks or combined procedures. Deciding in favor or against breast reconstruction is always individual, and the wish of the patient must be taken into consideration. Breast reconstruction is even possible several years after mastectomy.

Sentinel lymph node biopsy

It is important to know if and how many axillary lymph nodes are cancerous in order to plan cancer therapy. The sentinel lymph nodes are the first lymph nodes being supplied by lymphatic vessels originating in tumors. If lymphatic vessels transport cancerous cells to the lymph nodes, it is likely that they will be found in sentinel lymph nodes.

To find sentinel lymph nodes, a surgeon injects a harmless radioactive substance (technetium-99m) into the suspected cancerous area one day before surgery. The substance is transported to the sentinel lymph nodes and accumulates. This makes it possible to identify and remove the sentinel lymph nodes, which are also examined by a pathologist, who determines if they are tumor positive or tumor negative. If they are tumor negative, axillary dissection and, thus, the removal of other lymph nodes will not be necessary.