Breast Cancer Surgery in Boulder, CO

The most common breast problems seen in consultation with a breast specialist are:

• Breast Pain
• Nipple Discharge
• Breast Infections
• Breast Mass
• Breast Cancer

Breast Cancer

Most breast cancers are discovered with a routine mammogram, but can also be discovered by a palpable mass, bloody nipple discharge, abnormal skin changes, or breast pain (rarely). Breast cancer, when identified early, is very treatable and often curable. The earlier breast cancer is discovered, the greater the chance of providing effective treatment.

Once breast cancer has been diagnosed, the first step is to determine the treatment plan. Usually, breast cancer surgery involves the complete removal of the cancerous spots with a clear or negative margin around the cancer. There are two options to achieve this goal: lumpectomy (partial mastectomy) and mastectomy. Usually, an armpit lymph node is removed as well (the draining tissue of the breast). This is what constitutes surgical staging.

Early Detection and Surgical Treatment Options

Breast Conservation (Lumpectomy, Partial Mastectomy)

A lumpectomy involves removing the breast cancer mass and a margin of normal tissue around it. This is achieved through creating an incision in the breast with the attempt to maintain the majority of the breast appearance. Specifically, the nipple and areola are not removed. Often, the cancer is localized by the radiologist immediately prior to your surgery. They may use mammography or ultrasound to place a wire marker into the breast so that the surgeon knows where to operate. The wire and the cancer are removed during the lumpectomy.

If a clear margin around the cancer is not achieved, another procedure might need to be performed at a later date. This is called a re-excision and involves reopening the same incision and shaving a margin of tissue in the area where the margin was not optimal. If a re-excision cannot achieve clear margins, a mastectomy may be the only option.

If cancer is found throughout the entire breast, or if the mass is large relative to a small breast, a mastectomy may be the best option in these cases. Women who are lumpectomy candidates may also choose mastectomy for personal reasons. Women who elect to have a lumpectomy will generally require post-operative radiation treatment to the remaining breast tissue. If a woman cannot have radiation, or chooses not to, mastectomy is the best option.

Breast Removal (Traditional and Nipple Sparing Mastectomy)

A mastectomy involves removing the entire breast. This typically includes removal of the nipple and areola. It generally does not involve removing any muscle.

If a woman does not wish to have cosmetic breast reconstruction, the skin will lie flat on the chest wall upon completion.

If a woman elects breast reconstruction, she will most likely have a skin-sparing mastectomy, which removes the nipple, areola, and underlying breast tissue while preserving the majority of the skin. Immediate breast reconstruction is performed in the majority of our patients. It is done in conjunction with a plastic surgeon. You will meet with them before surgery to discuss the available reconstructive options. In some instances, reconstruction may be delayed until a later date.

Sentinel Lymph Node Biopsy

Breast cancer surgery usually involves two parts: the removal of the breast cancer as outlined above and lymph node sampling. A lymph node is a gland that drains a surrounding bed of tissue.

The armpit lymph nodes are the usual drainage channels for breast disease. Historically, all of the lymph nodes were sampled to identify if breast cancer had spread outside the breast. This frequently resulted in permanent arm swelling (lymphedema), numbness, or tingling.

Currently, sentinel node biopsy is used to determine if the cancer has spread outside of the breast. This is a minimally invasive way of sampling a few armpit lymph nodes instead of removing all of them. This technique involves injecting the breast with a harmless amount of radioactive material that travels to the armpit (axilla) in the same manner as a breast cancer cell would.

The lymph nodes in the axilla drain in a particular order. The sentinel node or nodes are the first lymph node(s) to drain the breast. The lymph nodes of the armpit/axilla are the gateway to the rest of the body, so a positive sentinel node indicates a higher risk of having metastatic disease.

Chemotherapy

Not all women with breast cancer are recommended to undergo chemotherapy. Chemotherapy is generally given to prevent distant or metastatic disease from developing in the future. After breast surgery, a woman will consult with a medical oncologist who will discuss the potential role that chemotherapy may play.

The medical oncologist will administer the treatment if a patient elects to have chemotherapy. The duration and type of chemotherapy depend upon the combination of drugs selected to treat an individual’s particular cancer.

Radiation

Women who have had a lumpectomy and who have a cancer larger than 5 centimeters in diameter or who have more than four positive lymph nodes will usually be recommended to have radiation therapy following breast surgery. Radiation treats the remaining breast tissue and surrounding lymph nodes. The ultimate goal of radiation therapy is to prevent local recurrence.

Traditional radiation is given five days a week for five weeks.

The daily treatments are noninvasive, and side effects may include fatigue, skin irritation, or blistering. Partial breast radiation is a relatively new field in which the radiation is delivered to a more focused part of the breast for a shorter duration of time. This method is best suited for small tumors. It is still considered investigational. A radiation oncologist will ultimately help you decide what the best treatment will be for you.

Breast Cancer Navigator

Receiving a breast cancer diagnosis is always overwhelming, both emotionally and intellectually. There are many options regarding the type of surgery, chemotherapy, radiation, and coordination of these modalities.

A nurse navigator is the best resource to support and guide an individual through this challenging process. They provide emotional support, medical information, and logistic assistance so that the journey through breast cancer treatment can be as efficient and comprehensive as possible. They are the tour guides on your journey, so you do not get lost or miss any important sites.

Helping You Through the Breast Cancer Process

Boulder Community Hospital has a full-time Breast Health Navigator available for your support during this often confusing and difficult time. It is usually a challenge emotionally, socially, and financially. Nanna Bo Christensen, RN, CBCN, is a trained oncology nurse who provides support, education, and navigation regarding any breast health issues, including imaging procedures, surgery, radiation, chemotherapy, and hormone therapy.

Nanna Bo is available to:

• Help organize the vast amounts of clinical information.

• Ensure timely access to the care team, i.e., physicians, psychosocial support, social worker, genetic counselor, etc.

• Work with the physician team to ensure patient understanding of clinical information and treatment choices.

• Coach the patient though decisional conflicts and support informed medical decision making.

• Coordinate and streamline access to the different tests and procedures.

• Initiate discussion between the patient and their medical team regarding health and wellness during treatment i.e., exercise and nutrition.

• Identify non-medical resources and connect the patient to secondary navigators to ensure access to these needed services.

• Provide support and resources well into the post treatment survivor-ship phase.

Please feel free to contact her at 720-854-7057 with any additional breast health needs or for possible financial information regarding breast imaging procedures and/or treatment.

After Breast Surgery

• Breast conservation patients are usually treated as an outpatient (i.e., no inpatient hospital time).

• Mastectomy patients will usually spend 1-2 days in the hospital.

• After a mastectomy or complete axillary lymph node dissection, there will be a drain tube(s) at the site of your mastectomy or under your arm to collect residual fluid.

• You may experience some pain, swelling, and tenderness at the mastectomy site.

• You will be given pain medication for any pain.

• You will be able to resume normal activities, but should limit intense exercise or strain of upper extremities/chest muscles until your incisions have healed fully.

• If you have undergone a mastectomy, exercise your arm to restore its range of motion.

Continue your monthly self-breast exams to check for any changes in your breast or chest wall. You will have regular diagnostic imaging performed to monitor progress after breast conservation therapy (lumpectomy). After a mastectomy, the removed side will not require any additional routine imaging studies. Follow up after surgery depends on your diagnoses as well as the type of surgery you have undergone.

The most comprehensive treatment for breast cancer requires the involvement of multiple specialties of care. Alpine Surgical is committed to ensuring that you and all parties involved in your care are in constant communication and fully informed. Our goal is to coordinate and expedite your care so that you can focus on healing and enjoying your life.

Please call us today at 303‑449‑3642 to schedule an appointment or ask a question. The entire Alpine Surgical team is here to help with effective breast cancer surgery in Boulder, CO.