NCCN Guidelines for Patients
Breast Cancer – Locally Advanced (STAGE III)
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.
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.
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.
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
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
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
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).