Ever since Angelina Jolie publicly addressed her preventative bilateral mastectomy in 2013, many women have the idea that removing both breasts is typical care for breast cancer. While a bilateral mastectomy is still a popular option (both to prevent recurrence and to reduce anxiety about recurrence), there are actually many options for women with breast cancer to consider.
Breast Surgery Overview
The goals of surgery are to remove as much of the cancer as possible and also to examine the lymph nodes nearby to determine how much the cancer has spread locally. Thus, a breast cancer surgery often includes one incision on the chest where the cancer is removed and one in the underarm where the lymph nodes are removed for biopsy. There are also options for breast reconstruction (which is usually multiple surgeries), should someone desire it for cosmetic purposes.
- Options for breast surgery include:
- Breast-conserving surgery or BCS (lumpectomy, partial mastectomy, etc.) – removal of part of the breast which contains cancer and a margin of normal cells surrounding the tumor.
- Simple – removal of all breast tissue including nipple and areola (and usually some skin, but it is possible to have skin- and/or nipple-sparing procedures).
- Modified radical – removal of all breast tissue along with all lymph nodes under the arm.
- Radical – removal of all breast tissue and the chest wall muscle (this surgery is rarely done unless the cancer has spread into the chest wall).
- Types of lymph node removal include:
- Sentinel lymph nose biopsy (SLNB) – removal of the lymph node(s) to which the cancer would likely spread first
- Axillary lymph node dissection (ALND) – removal of many (usually less than 20) lymph nodes from under the arm
- Optional breast reconstruction can include:
- Autografts – tissue from another part of the body is used to recreate the breast (Reconstruction options are a whole post in itself!)
Many breast surgeons now push for breast conserving surgery (BCS) because having a more aggressive surgery doesn’t always result in better quality of life or reduce cancer survival rates significantly. In fact, having BCS in combination with radiation therapy has been proven to be equally, if not more, effective at improving survival rates than a mastectomy alone.1, 2 This information is especially important for those with triple negative breast cancer who do no have the option of hormonal therapy.
Of course, cancer stage (how large the tumor is and whether the cancer has spread) and grade (how quickly the cancer is growing) both influence the type of surgery and treatment someone may need. Discuss with your oncologist and surgeon which option is the best for you in your recovery.
No matter the type of surgery a person chooses for breast cancer treatment, a physical therapist is an integral part of post-surgical recovery. PTs help to maximize the body’s natural healing process, restore range of motion to the shoulder, neck and chest wall after surgery, perform scar mobilization and soft tissue work to the affected muscles, and (most importantly) help people to return to their usual activities!
Some post-op considerations for physical therapy after breast cancer include care of post-surgical drains, observance of proper wound care at the incision site, monitoring for signs of infection, and protecting sensitive skin with post-operative radiation. While all PTs are able to treat a patient post-surgically, there are oncology physical therapists who have more training to look for other complications, especially early signs of lymphedema and cording (stay tuned for my next post).
If you or a loved one are interested in trying physical therapy after breast cancer, ask your doctor for a referral. Most oncologists and breast surgeons work closely with physical therapists and they can send you to a PT they trust in your area. If you want to do some research on physical therapists who are familiar with breast cancer rehabilitation in your area, you can use the APTA PT Locator or search through the APTA Academy of Pelvic Health.
Hope this information is helpful – go schedule with your PT today!