Many patients diagnosed with breast cancer have to undergo a surgical procedure to remove the cancerous region. The type of procedure performed largely depends on the individual and staging of the cancer.
The type of surgery performed can have a strong impact on shoulder and upper body mobility and function post-operatively. It’s not uncommon to experience shoulder joint restrictions leading to decreased range of motion, decreased strength, poor posture, and associated pain.
Before looking into the possible shoulder and mobility restrictions that can develop for each surgical procedure, let’s first find out what the surgical options are to treat breast cancer.
Lumpectomy
A lumpectomy is the most conservative form of surgery to remove breast cancer. It is also known as breast-conserving surgery. A lumpectomy is commonly performed in early stages of a diagnosis.[1]
During a lumpectomy, the tumor itself is removed, possibly along with other tissue borders.2 Depending on the individual, sometimes a sentinel lymph node biopsy may be performed to determine if there has been any spread of the cancer to the lymph nodes.
Simple Mastectomy
A simple, or total, mastectomy surgically removes the entire breast. This includes removal of the nipple, areola and skin.3 A sentinel lymph node biopsy may occur during a simple mastectomy.
Modified Radical Mastectomy
A modified radical mastectomy is ultimately the same procedure as a simple mastectomy. The primary difference between the two is that a sentinel lymph node biopsy is commonly performed during a simple mastectomy, whereas an axillary lymph node dissection is more often performed in a modified radical mastectomy.[4]
An axillary lymph node dissection is a more extensive removal of lymph nodes from the axilla, or armpit, versus a biopsy usually only removes the first few lymph nodes that drain a tumor that was removed for biopsy purposes.
Radical Mastectomy
A radical mastectomy is not as commonly performed due to its aggressiveness.
It fully removes the breast, nipple, areola and skin just like the simple and modified radical mastectomy; however, it also involves the removal of the pec muscles in the chest.[2,4]
An axillary lymph node dissection is also common to perform with a radical mastectomy.
Skin-Sparing Mastectomy
A skin-sparing mastectomy is used for patients who are planning reconstruction after their mastectomy.
In this surgery a large amount of skin is left in place for the reconstruction procedure. The breast tissue, areola and nipple are still removed during this type of mastectomy.[4]
This type of mastectomy may not be possible if a large tumor is present near the skin surface.[4]
Nipple-Sparing Mastectomy
A nipple-sparing mastectomy is similar to a skin-sparing mastectomy in that the breast tissue is removed and the skin is spared, however, the nipple and areola are also spared.[4]
During surgery, breast tissue is normally removed from directly under the nipple and areola. If cancer is found in this tissue, then the nipple and areola will have to be removed, changing this procedure then to a skin-sparing mastectomy.[4]
This surgery is commonly performed in patients with early-stage breast cancer that is not near the nipple or affecting the nearby skin.[5]
Reconstruction is common after a nipple-sparing mastectomy.
Double Mastectomy
During a double mastectomy, both breasts are removed simultaneously. This is commonly performed to remove cancer presence in both breasts; or some patients will opt to have the second breast removed to reduce their chances of cancer recurrence or development in the healthy breast if they are considered high risk.5
Conclusion
After reviewing and describing the possible surgical options for removal of breast cancer, future discussions and posts will include post-operative challenges with shoulder and postural range of motion and mobility, and the role of rehab to recover.
Resources
- Lumpectomy - Mayo Clinic. Mayoclinic.org. Published 2018. https://www.mayoclinic.org/tests-procedures/lumpectomy/about/pac-20394650.
- Types of Breast Cancer Surgery. GW Cancer Center. https://cancercenter.gwu.edu/specialties/breast-cancer/types-breast-cancer-surgery.
- Modified radical mastectomy. Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/breast-cancer/multimedia/modified-radical-mastectomy/img-20007832.
- Cancer.org. Published 2014. https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/mastectomy.html.
- Double Mastectomy. Cancer Treatment Centers of America. Published March 10, 2021. https://www.cancercenter.com/cancer-types/breast-cancer/treatments/surgery/double-mastectomy.
