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Roughly 4,000 Hoosier women are diagnosed with breast cancer each year, and about 40 percent – a growing number – of those women will opt for mastectomy.

In recognition of Breast Cancer Awareness Month this October, Dr. Linda Han, director of breast surgical oncology at the IU Health Melvin and Bren Simon Cancer Center, discusses the role of a surgical team when diagnosing and treating breast cancer.

How is breast cancer diagnosed?

After a breast abnormality is detected by the woman, physician, or breast imaging such as a mammogram, ultrasound or MRI, it is usually confirmed through biopsy. If the lump is determined to be breast cancer, as opposed to a benign cyst, a surgeon will perform a breast exam and review the images and pathology to confirm the diagnosis.

How is surgery part of the breast cancer treatment process?

After breast cancer is diagnosed, the first step is to remove the tumor. A surgeon discusses the options: lumpectomy, which removes the tumor and preserves the breast, or mastectomy, which is the complete removal of the breast if the tumor is large. The surgeon may recommend chemotherapy prior to surgery to shrink the tumor and help avoid a mastectomy.

What are lymph nodes and how do they factor into diagnosis and treatment?

Lymph nodes, as a part of the immune system, filter harmful cells in the body. The lymph nodes can be the first place that cancer cells spread, and in breast cancer, it usually spreads to the nodes underneath the arms. A surgeon will typically remove the lymph nodes that may be involved – a technique called sentinel node mapping – to determine if the cancer has spread.

How have breast cancer surgeries improved in the last 10 to 20 years?

In the past, the focus was on simply removing the cancer with as much tissue as possible as well as all nearby lymph nodes. These radical surgeries often caused complications such as arm swelling and chronic pain. With expanded knowledge, surgical techniques have improved, diminishing side effects. Lumpectomies are performed through very small incisions and advances in “oncoplastic” techniques allow surgeons to remove larger cancers without a mastectomy and reshape the breast tissue for an improved appearance. If a mastectomy is necessary, a surgeon can remove the tumor and breast tissue while preserving the skin and nipple for optimal reconstruction.

What are a patient’s options for breast reconstruction?

It is well established that reconstruction results in improved quality of life, self-esteem and sexuality. Both silicone and saline implants are safe and have a wide range of sizes that can be customized to the woman’s frame while tissue transfer flaps use the woman’s own tissue to rebuild the breast. Reconstruction can be performed immediately at the time of surgery, or delayed; this is dependent on the need for further treatment, such as radiation.

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