Breast Cancer Surgery

Overview

What is breast cancer surgery?

If you have localized breast cancer, your healthcare team will almost always recommend surgery to remove it. Surgery is considered the primary treatment for breast cancer when it's technically possible to remove the affected tissue. (It's not 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 (lumpectomy), and other times it may be necessary to remove your entire breast (mastectomy) to remove the cancer. Breast surgery for cancer is primarily a treatment, but it can also be diagnostic and even cosmetic. Sometimes surgery is exploratory to look for signs of cancer spreading. Sometimes it involves reconstructing your breast after a mastectomy.

The type of surgery that your healthcare team recommends for you will depend on many individual factors, including the type of cancer you have, how advanced it is, your general health and your personal preferences. Depending on your condition, surgery may be only a piece of your overall treatment plan, or it may be the only treatment you need.

What are the different types of surgeries for breast cancer?

The two types of surgery used to treat breast cancer are mastectomy and lumpectomy. Additional surgeries for breast cancer may include lymph node dissection (lymphadenectomy) and breast reconstruction surgery.

Mastectomy

Mastectomy, or breast removal surgery, is the most common surgery for breast cancer. That’s because mastectomy treats both late-stage and early-stage breast cancers. In addition, some people with a high risk of developing breast cancer in the future choose prophylactic mastectomy as a preventative measure.

Types of mastectomy procedures include:

• Total mastectomy: Removal of your entire breast, sparing your chest muscle beneath.
• Double mastectomy: Removal of both breasts. This may be necessary if the cancer has already spread to both breasts, or it may be a preventative measure.
• Skin-sparing or nipple-sparing mastectomy: Removal of all your breast tissue, but sparing your skin and, if possible, your nipple, to use to reconstruct your breast.
• Modified radical mastectomy: Removal of your breast tissue and your underarm lymph nodes. Lymph nodes are often the first place that breast cancer spreads to.
• Radical mastectomy: Removal of your breasts, underarm lymph nodes and chest muscles. This is a rare surgery, only necessary when breast cancer has infiltrated your chest muscles.

Lumpectomy

Lumpectomy, also called breast-conserving surgery, removes only part of your breast tissue. This is an alternative option for treating earlier-stage breast cancer. When the tumor is relatively small and hasn’t spread yet, you can have surgery just to remove the “lump” — the tumor itself. Lumpectomy also removes a margin of the surrounding tissue, just to make sure there aren’t any stray cancer cells left in your breast.

The benefit of lumpectomy is that it allows you to keep most of your breast. But to prevent breast cancer from returning, your healthcare provider will most likely recommend radiation therapy after the surgery. Having a total mastectomy instead is often a way of avoiding radiation therapy. But for people who have the option, lumpectomy with radiation therapy has been shown to be equally effective to total mastectomy in treating early-stage breast cancer.

Types of lumpectomy procedures include:

• Excisional biopsy: This is a procedure to remove a tumor for biopsy. Analyzing the tumor in a lab can help determine if the tumor is cancerous (malignant).
• Wide local excision: Surgery to remove a cancerous tumor and a margin of tissue around it. The marginal tissue will be tested afterward to make sure it’s cancer-free.
• Quadrantectomy: A segmental mastectomy that removes about a quarter of your breast, including your duct-lobular system. Recommended when the tumor shows ductal spread.
• Re-excision lumpectomy: A procedure that follows the original excision of the tumor and the margin of tissue around it. When the marginal tissue tests positive for cancer cells, your surgeon will reopen the surgical site to remove an additional margin of tissue until the tissue comes back cancer-free.

Lymph node dissection

Your lymph system is often the first place cancer spreads, and cancer in your lymph nodes is a warning sign that it may be spreading beyond your breast. To find out, your surgeon may remove and analyze one or several of the lymph nodes under your arm next to your affected breast. This is where breast cancer cells would be most likely to drain.

Lymph node procedures include:

• Sentinel lymph node biopsy: This is an investigative procedure to find out if cancer has spread to your lymph system. The sentinel lymph node is a good indicator because it's the first node that filters fluid draining away from the affected breast. Your surgeon will often perform a sentinel node biopsy during the operation to remove the original tumor from your breast — and sometimes before. They'll remove the sentinel node and analyze it for cancer cells.
• Axillary lymph node dissection: If the sentinel node biopsy tests positive for cancer, or if your surgeon has other reason to believe you have pervasive cancer in your lymph nodes, they may want to remove a larger portion of lymph nodes to analyze. In an axillary lymph node dissection, your surgeon removes a pad of fatty tissue containing a group of axillary lymph nodes (the lymph nodes under your arm). They'll carefully search through the tissue for signs of cancer.

Reconstructive breast surgery

If you're having some or all of your breast or breasts removed to treat breast cancer, you may be interested in reconstructive surgery to restore your breast shape. Surgeons can often rebuild the breast with plastic surgery techniques immediately following your lumpectomy or mastectomy. They can also perform a separate surgery at a later time, such as after you've finished radiation therapy or chemotherapy treatment and your tissues have had time to recover.

Regardless of whether you have immediate or delayed reconstruction surgery, you may need an additional follow-up surgery to perfect your results. Follow-up surgeries may adjust the size balance between your breasts, for example, or add a reconstructed nipple. Breast reconstruction can use a mix of different methods and can happen in stages. You and your surgeon will determine the right methods and timing based on your condition and preferences.

Breast reconstruction methods include:

• Implant reconstruction: A breast implant replaces the tissue that was removed from your breast to restore its shape and volume. The implant is a silicone shell that’s filled with either saline or silicone gel. The surgeon places it over or under your muscle and covers it with your skin — either your original breast skin or a skin graft from another part of your body.
• Autologous or “flap” reconstruction: This method takes tissue from another part of your body to reconstruct your breast. Skin, fat and sometimes muscle from areas such as your belly or buttocks tend to better resemble breast tissue in look and feel. Sometimes surgeons use a combination of flap and implant reconstruction for more realistic results.
• Nipple reconstruction: If you had a nipple-sparing mastectomy or lumpectomy, your surgeon preserved your nipple to use in the reconstruction of your breast. If they weren’t able to preserve your original nipple, they can construct a new one from a skin graft taken from another part of your body. This may be done in a follow-up surgery after breast reconstruction.