NCCN Guidelines for Patients® | Stage III Breast Cancer
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41

NCCN Guidelines for Patients

®

:

Breast Cancer – Locally Advanced (STAGE III)

Version 1.2017

4

Surgery

Breast reconstruction

Axillary lymph node dissection

A surgical cut will be made into your armpit. Through

this cut, lymph nodes and fat will be removed. Side

effects for sentinel and axillary dissections are

alike. However, they are more common with axillary

dissection. They can also be more complicated.

There is a greater chance for lymphedema.

Breast reconstruction

Some women choose to have breast reconstruction.

Others use an external fake breast called a

prosthesis. Some women do nothing. Breast

reconstruction is briefly described next. Talk with your

doctor about your options. More information can be

found at the websites listed in Part 9.

After lumpectomy

If you will have a lumpectomy, your breast can be

re-shaped using volume displacement. Volume

displacement is the shifting of the remaining breast

tissue so as to fill the hole left by the lumpectomy. It

helps keep the natural look of your breast. Shifting of

the breast tissue is often done by the cancer surgeon

right after the lumpectomy.

You may not like the results of your lumpectomy

even after volume displacement. In this case, breast

revision surgery may help. Breast revision surgery is

done by a plastic surgeon. Revision options include

a second volume displacement, breast implants, or

flaps. Breast implants and flaps are described next.

After mastectomy

The timing of breast reconstruction differs after

mastectomy. Reconstruction at the same time as the

cancer surgery is called immediate reconstruction.

Delayed reconstruction can occur months or years

after the cancer surgery. Breast reconstruction

following a mastectomy is done by a plastic surgeon.

To enhance breast reconstruction, you may be

able to have a skin-sparing mastectomy. This

surgery usually removes only the breast, nipple,

and areola. Your breast skin is sparred. As a result,

the mastectomy scar will be smaller and your

breast will have a more natural shape. Skin-sparing

mastectomy can be done for some women. Ask your

surgeon if this is an option for you.

All breast reconstruction is generally safe. However,

with any surgery, there are risks. Ask your treatment

team for a complete list of side effects. Women

who smoke or are obese are more likely to have

problems.

Implants

Breast implants are small bags filled with salt

water, silicone gel, or both. They are placed under

the breast skin and muscle to reconstruct breasts.

Implants have a small risk of breaking and leaking.

There is a low but increased risk for a rare type of

lymphoma.

A balloon-like device, called an expander, may first

be placed under your muscle or skin. It then will be

inflated to stretch out your muscle and skin. Every

few weeks for two to three months, the expander

will be enlarged. When the implant can fit, a second

surgery will be done to exchange the expander for

the implant.

Radiation can affect implant reconstruction. An

expander is not likely an option if you have had

radiation therapy to the breast. Your best option may

be a flap. If no radiation has been received, a two-

step process is advised. Placement of an expander

should occur at the end of the cancer surgery.

Placement of the implant follows at a later time.

Reconstruction with implants can cause pain. You

may feel pain from the expander stretching your skin

and muscle. Some women will also have pain from

the implant, scar tissue, or tissue death (necrosis).