Partial Mastectomy with Axillary Dissection and Radiation
© Steven C. Immerman, MD, FACS, 2000
This operation was developed because of its cosmetic superiority to mastectomy. Patients have been followed for over 20 years after this operation, and so far no difference in survival has been detected when compared with mastectomy. Although the breast is not completely removed, this option does not mean less treatment; it actually is more complicated than mastectomy, as you will see below. It consists of three parts:
- partial mastectomy
- axillary dissection
- radiation therapy
This part of the treatment consists of removal of the lump with an outer rim of normal tissue. To determine if this has been accomplished, the pathologist looks at all the outer edges of the area removed. If he feels that the removal around the cancer is adequate, he says it has negative margins. Determining the margins can be a difficult and time consuming task for the pathologist. If there is an obviously involved margin he may be able to determine this right away, and additional tissue can be removed during the same procedure. Otherwise, we have to wait for the permanent section report which takes a few days to prepare. If the margins come back positive on the permanent section report, the surgeon will have to either go back and remove more tissue, or reconsider performing a mastectomy.
After the partial mastectomy has been successfully completed the lymph glands in the armpit must be removed. The medical term for armpit is axilla. The removal of these lymph nodes is called an axillary dissection. This operation is usually done as an outpatient under general anesthesia (asleep).
The lymph nodes (also called lymph glands) are part of the body's immune system. They filter the lymph, which is a clear fluid that travels throughout the body separately from the bloodstream. The lymph nodes remove any bacteria or abnormal cells that may be traveling through the lymphatic system. The lymph nodes in the armpit filter the lymph coming from the arm and breast. We try to remove the nodes that drain the breast and leave as many of the nodes that drain the arm as possible. If all the lymph glands draining the arm were removed, there would be permanent arm swelling. The removal of this small amount of lymph node tissue does not affect the body's overall ability to fight infection or cancer in any way.
The axillary dissection is done in by removing all the lymph glands in a certain predefined area. We do not attempt to remove any certain number of lymph glands. The glands are removed in one large cluster and sent to the pathologist. He will look through the cluster, separate out each lymph gland, and prepare a microscopic slide of each one. We will get a report on the glands two to three days from the operation.
At some point after a patient has healed from the operation an appointment is made with the radiation therapist, who will discuss the details of the radiation treatment. He will decide on the treatment field, which is the area of the breast that will receive the radiation. The first appointment may be lengthy because they have to set up the treatment field; however, after that the treatments will only take about 15 minutes. Patients usually come in for a treatment every weekday for about five to six weeks until they have received the total dose of radiation. In general, the main side effects are mild redness, swelling, and tenderness of the breast. The treatments themselves are not painful.