Breast Cancer Surgery

What is breast cancer surgery?

If you have breast cancer, your healthcare team will almost always recommend surgery to remove it — either before or after other types of treatment. Breast cancer surgery is the most effective means of breast cancer removal when it’s technically feasible to remove it. (It’s not necessarily an effective treatment for metastatic breast cancer — when the cancer has already spread to other parts of your body.)

Sometimes, breast cancer surgery removes an individual tumor from your breast. Other times, it might be necessary to remove your entire breast to remove the cancer. Breast surgery for cancer is primarily a treatment, but it can also be diagnostic or even cosmetic. You might have exploratory surgery to look for signs of cancer spreading. You might also have surgery to reconstruct your breast after cancer treatment.

What are the different types of breast cancer surgery?

Surgical procedures for breast cancer removal include:

• Lumpectomy (partial mastectomy): This procedure removes an individual tumor (“lump”) from your breast, with a margin of healthy tissue around it. A lumpectomy is an option when treating breast cancer in the early stages.
• Mastectomy: A mastectomy removes all of one or both breasts. Some types of mastectomies also remove other affected tissues in the area, like chest muscles or other structures of the chest wall.

Additional surgeries for breast cancer may include:

• Sentinel node biopsy: This procedure removes one to a few lymph nodes next to your affected breast for testing to determine if breast cancer has spread there.
• Lymphadenectomy: This removes and dissects most of your underarm lymph nodes next to your affected breast to determine if cancer has spread to multiple lymph nodes.
• Breast reconstruction: This surgery restores your breast shape after breast cancer removal. Your surgeon might use breast implants, your own tissue or both.

The type(s) of surgery that your healthcare team recommends will depend on many individual factors, including the type of breast cancer you have, how advanced it is, your general health and your personal preferences. For some people, surgery may be the only treatment they need. For others, it may be only a part of a larger treatment plan. Most people will have more than one surgical procedure.

How urgent is breast cancer surgery?

Cancer treatment is always urgent. The sooner you begin treatment, the better your chances of stopping the cancer from progressing. Statistically, breast cancer surgery has a better success rate when it occurs within eight weeks of your diagnosis. This is true regardless of the stage of cancer you have. However, there are some cases where you might have another type of treatment before surgery.

What stage of breast cancer requires surgery?

Surgery is the primary treatment for breast cancer in all stages except the last (Stage V, also called metastatic breast cancer). When breast cancer has spread beyond the region of your breast to distant regions, like your liver, lungs or brain, you’ll need a more systemic type of treatment. This means treatment that targets cancer throughout your body, like chemotherapy or radiation therapy.

Is breast cancer surgery a major surgery?

Some types are and some aren’t. For example, sentinel node biopsy and lumpectomy are relatively minor procedures by themselves. But if you have them both at the same time, your surgery and recovery will be longer.

Mastectomy and breast reconstruction are both longer procedures by themselves, and they can also happen at the same time. With longer procedures, the risk of complications is also higher.

What happens before breast cancer surgery?

Once your healthcare provider has diagnosed breast cancer, they’ll schedule a meeting with you to discuss your surgery options. Your health condition and the stage of the cancer will inform your overall treatment plan and where surgery fits in. Usually, in early-stage breast cancer, surgery is the first step in treatment. You’ll also consider whether you want to have breast reconstruction surgery, and when that would take place.

What happens during breast cancer surgery?

Your breast cancer surgery will be tailored to your individual needs based on your discussions with your healthcare team. Your surgeon will try to remove any tissue that may have cancer cells in it. This may include removing a portion of your breast, all of your breast or both breasts. It may also include removing and dissecting a few or all of the axillary (underarm) lymph nodes next to your affected breast.

If you’ve opted for breast reconstruction, your surgeon may begin or complete your reconstruction during the same surgery. This may involve additional wounds to your body — for example, if your surgeon needs to take tissue from another place on your body to reconstruct your breast. Alternatively, you may choose to delay breast reconstruction until after you’ve completed your cancer treatment.

How long does breast cancer surgery take?

How long it takes will depend on the type of procedure and how extensive it is. In general, a simple lumpectomy, with or without sentinel node biopsy, can usually be done in one to two hours. On the other hand, a mastectomy with axillary lymph node dissection or breast reconstruction at the same time may take up to three to four hours in surgery. You may have to stay in the hospital for one or more nights afterward.

What happens after breast cancer surgery?

While you’re recovering from surgery, a pathologist may be working on your lymph node biopsy results. They’ll want to make sure they’ve removed all of the cancer cells in your body. When they have their results, they’ll discuss these and next steps with you. If they find cancer in your lymph node(s), you might need additional treatment, like chemotherapy, radiation therapy or additional surgery.

What are the possible risks or side effects of breast cancer surgery?

General surgery risks and complications include:

• Wound infection: Telltale symptoms of infection include fever or redness and heat at the site.
• Blood clots: Call your healthcare provider if you develop a painfully swollen leg, chest pain or shortness of breath.
• Seroma: This is a build-up of fluid at the surgical site. It usually goes away on its own, but you can have the fluid drawn with a needle if it bothers you or if it gets infected.
• Hematoma: This is when blood collects in the tissues around the wound, causing pain and swelling. It goes away on its own, but it can take several months. You can have the swelling drained if you need to.

Specific side effects that may occur after breast cancer surgery include:

• Numbness and tingling: Nerve damage during surgery may cause numbness, tingling or pain in your chest, armpit, upper arm or shoulder. The nerves usually repair themselves, but it may take several weeks. Your healthcare provider can prescribe pain medications if you need them.
• Shoulder stiffness: Stiffness, weakness and a reduced range of motion in your shoulder and arm are common after breast surgery. This may last a few weeks. Your healthcare provider will show you some daily exercises to practice during your recovery to help prevent shoulder stiffness.
• Cording: Some people who had surgery on their axillary lymph nodes develop axillary web syndrome, also known as cording. Hardened lymph nodes produce a tight cord of tissue that runs from your armpit down your arm. You might need to massage it to help stretch it out.
• Lymphedema: Disruption of your lymph drainage system can sometimes cause swelling in your arm or hand. Some swelling in the first week after surgery is normal, but if it continues, you might have a more lasting condition called lymphedema. It’s not curable, but it’s treatable.

How long is the recovery time from breast cancer surgery?

You may be sore and have limited movement in your chest and arms for a few weeks afterward. Your healthcare provider will send you home with painkillers and arm and shoulder exercises to practice daily. These are important to prevent stiffness. You may feel tired for a while. It can take several weeks to regain your former energy levels. Most people are able to resume normal activities after a month.

What is the survival rate after breast cancer surgery?

According to the National Cancer Institute’s Surveillance, Epidemiology, and End Results (SEER) database, the five-year relative survival rate for people who undergo treatment for breast cancer is 91% (all stages combined). Survival rates are 99% when breast cancer is only localized in the breast at the time of surgery. They fall to 86% if it’s spread to lymph nodes, and 30% if it’s spread to other organs.

What type of scar will I have after breast cancer surgery?

Any type of surgery will leave a scar. Breast surgery scars differ from person to person, depending on the type of operation you had, the cuts (incisions) your surgeon made and the way they healed. Most scars will gradually reduce over time. They may look red and raised at first, then flatter and paler after a few months. With reconstructive breast surgery, surgeons attempt to hide your scars as much as possible.

When should I see my healthcare provider?

Your healthcare team will schedule a follow-up appointment about one to two weeks after your surgery. During your appointment, they’ll assess your condition, fill you in on any test results and plan the next steps in your treatment plan. Be sure to see your healthcare provider sooner if you experience any signs or symptoms of complications following your surgery, like excessive swelling, fever or cording.