The treatment: surgery

A century ago, people took away not only the affected mammary gland, but also the pectoral muscles and axillary glands. A large part of the skin was also removed so that skin grafting was often necessary. These procedures were very mutilating and also very often led to the development of a significant lymphedema of the arm (fat arm). In 1930, the technique was modified: the breast was still completely removed, but the large pectoral muscle was preserved. Henceforth, less skin was also removed, so that the result was aesthetically better. Another 50 years later, in 1980, the Italian surgeon Veronesi developed the breast-sparing technique, where he was able to prove that in many situations a partial removal of the breast gives as good a chance of healing as the complete mastectomy.

Surgical removal of the cancer

Today there are two options. Either one removes the breast completely (mastectomy) or one performs a breast-conserving surgery in which only part of the affected breast is removed. The latter option depends on a number of conditions: the size of the breast, the size of the tumor, the possibility of removing the tumor with a safe rim and finally, it must be a tumor that is confined to one place in the breast and does not proliferate in several places.

The cosmetic results of breast-conserving surgery vary depending on

the location and size of the tumor, but also the size of the breast is  

determine the final result. The removal of a small tumor from a large breast gives better aesthetic results than the removal of a large tumor from a small breast, for example. The skill of the surgeon also plays a role here.

Removal of the lymph nodes (axillary gland excision, axillary gland septum)

In breast cancer, axillary glands (lymph nodes in the armpit) are sometimes removed for two main reasons: to know if the cancer has spread and to prevent further spread.  

The axillary glands are often the first place breast cancer cells metastasize to. When cancer cells are present in one or a few axillary glands, all of the axillary glands will be removed. To know if a gland is affected, the surgeon performs the sentinel gland procedure at the beginning of surgery. A small amount of radioactive liquid is injected into or around the tumor. This substance enters the lymphatic ducts and then the axillary glands. With a special camera, the surgeon can follow the fluid and easily find the first lymph node or glands where the lymph from the breast enters. This first gland is called the sentinel gland (there are often one to three). The surgeon removes them and immediately delivers them to the lab where the gland is examined microscopically. If there are cancerous cells in it, the surgeon will detect and remove all the axillary glands (axillary clearing). If no cancer cells are found in the sentinel gland, he will leave the other axillary glands in situ. If the glands can be left in place, the risk of a swollen arm after surgery is less and recovery is often faster. If they have to be removed, then you are at greater risk of a fat arm, sensory disturbances in the arm and reduced arm mobility. These side effects can be greatly reduced with appropriate physical therapy. Also, your arm can infect more easily, with a small wound or an insect bite scratched open, for example. Lymph nodes are part of the immune system. Removing them makes your arm more vulnerable.

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