This procedure removes a tumor (lump) and a small amount of normal tissue around it. Sylvester cancer surgeons pioneered the technique for oncoplastic lumpectomy and now teach other surgeons around the country. During a lumpectomy, your surgeon removes the tumor and a small area of surrounding tissue. Your doctor sculpts the remaining breast tissue to give your breast a natural appearance, with touch-ups to the other breast to make them match.
Lumpectomy with Breast Reduction
For women with large breasts, the surgical oncologist and plastic surgeon can do breast-reduction surgery, starting with the cancerous breast to make sure the removed tissue contains the lump and a clean — or safe — margin around the lump. The plastic surgeon reduces the other breast to match.
This surgery, also called a segmental mastectomy, removes a larger part of the breast than for a lumpectomy.
Skin and Nipple-Sparing Mastectomy
When appropriate and possible, this procedure preserves the skin and nipple to minimize scarring and improve your surgeon's ability to reconstruct your breasts.
A mastectomy removes the entire breast that's affected by cancer. The surgeon may remove one or more of the lymph nodes under your arm during surgery, or as a separate procedure later, to see if cancer has spread.
If you have a mastectomy, you may choose to have breast reconstruction surgery during at the same time, or you can decide to do it later. Your surgeon may perform an oncoplastic lumpectomy, or your breast cancer surgeon and a plastic surgeon can work together to do reconstructive surgery. New techniques make it possible to create a breast that's close in form and appearance to your natural breast.
Sentinel Lymph Node Biopsy
Doctors use this minor surgery to determine if cancer has spread beyond a primary tumor into your lymphatic system. A sentinel lymph node is the first place cancer cells may move to when they begin to spread. During the biopsy, your doctor injects a special dye (tracer) to locate the nodes and remove them to look for cancer cells. If they're free of cancer, it means it's unlikely that cancer has spread and it's not necessary to remove more lymph nodes.
Sylvester offers a novel treatment that prevents taking more lymph nodes, even if the sentinel node is suspicious. Before surgery, an ultrasound scan of the armpit can highlight which lymph nodes are involved (they will appear enlarged or swollen). When chemotherapy is used before surgery (neoadjuvant chemotherapy), it can convert a previously positive lymph node to negative when biopsied, which means more lymph nodes don't need to be removed.
Venous Lymph Node Transfer and Lymphatic Grafting
If you have lymphedema from a previous surgery, Sylvester’s expert surgeons can prevent or provide relief from the debilitating condition caused when cancerous lymph nodes in the armpit must be removed during surgery, disrupting the normal flow of lymphatic fluid out of the arm. With nowhere to go, the fluid backs up in the tissues of the limb, causing painful swelling. In vascularized lymph node transfer, lymph nodes and their blood supply are transferred into regions where lymph nodes have been dissected to restore normal drainage.
If you have a cancerous phyllodes tumor that hasn’t spread outside your breast, your doctor may include radiation therapy as part of your treatment to destroy remaining cancer cells after the tumor has been removed.
Chemotherapy is cancer-fighting medicine that's administered intravenously or by a pill. Chemotherapy also might be recommended before surgery, called neoadjuvant chemotherapy, to help reduce the size of the tumor and improve surgical results. Often, more than one chemotherapy medicines are used at the same time or one after the other to destroy different kinds of cancer cells that come from the same breast cancer.
Follow-Up Care After Phyllodes Treatment
These tumors sometimes can recur in the breast itself; or, if you had a mastectomy, they can develop in the skin and underlying tissues of the breast. Most recurrences happen within a year or two of surgery. Cancerous phyllodes tumors may return more quickly than benign phyllodes tumors.
To ensure any recurring tumors are caught at the earliest stages, your doctor will design a follow-up plan including:
- Clinical breast exam within four to six months
- Mammogram, ultrasound, and possibly breast magnetic resonance imaging (MRI) six months after treatment, and on a regular basis
- Computed tomography (CT) scans of your chest and abdomen for two to five years if your phyllodes tumor was cancerous and you're at increased risk for a recurrence