Breast Cancer Surgery

Most people who are diagnosed with breast cancer have one or more surgeries as part of their treatment. Surgery is often one of the first steps in the sequence of breast cancer treatment.

Surgery may be done for a variety of reasons. It can be used to remove a tumor in the breast, check the lymph nodes for cancer, restore the shape of the breast, or ease symptoms when cancer has spread to other parts of the body. 

The first surgery to remove breast cancer is usually scheduled within eight weeks of diagnosis.

Other surgeries, such as reconstruction, can sometimes take place at the same time as the surgery to remove the cancer, or may take place months or years later. 

 

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Breast Cancer Surgery: How to Make an Informed Decision

 

Lumpectomy, also known as breast-conserving surgery, is the removal of only the tumor and a small amount of surrounding tissue. Typically, the cancer needs to be early-stage, small relative to the size of the breast, and affecting only one area of the breast for lumpectomy to be an option. Some people are candidates for having an oncoplastic lumpectomy, which involves using techniques to improve the appearance of the breast after removing the cancer.  

Mastectomy is surgery to remove the entire breast. There are several types of mastectomy and some remove all the breast tissue while others leave some or all of the breast skin, the nipple, and the areola intact. A mastectomy can be done on one breast (called a unilateral mastectomy) or both breasts (called a double or bilateral mastectomy). People who’ve never had breast cancer but are at high risk may opt to get a prophylactic (or preventive) mastectomy.

Some people diagnosed with breast cancer have surgery to remove some lymph nodes in the armpit area so they can be checked for cancer cells. This helps your doctors know if cancer has spread beyond the breast and determine the best treatments for you. Lymph node removal is usually done during a lumpectomy or mastectomy, or it may be a separate procedure. 

Occasionally, a more extensive surgery to remove more lymph nodes (axillary lymph node dissection) may be needed. This can raise the risk of lymphedema (abnormal swelling). Some people are candidates for a procedure called lymphovenous bypass that is done right after the lymph nodes are removed. It involves connecting damaged lymphatic vessels to nearby veins and it helps prevent lymphedema from developing. 

Breast reconstruction is surgery to rebuild the breast after mastectomy and sometimes lumpectomy. Reconstruction can take place at the same time as cancer-removing surgery, or months to years later. It’s usually done by a plastic surgeon who specializes in breast reconstruction. There are two main types: flap reconstruction, which uses tissue and fat from another part of the body to recreate the breast, and implant reconstruction, which uses a silicone shell that’s filled with silicone gel or salt water to recreate the breast. Another option that some people are candidates for is a Goldilocks procedure (also known as a SWIM procedure). It’s done at the same time as the mastectomy and uses fatty tissue and skin to create a small breast mound.

Some people also choose to later get nipple reconstruction surgery or nipple tattoos.  

After a mastectomy, some people prefer not to get breast reconstruction or aren’t candidates for it. Leaving one or both sides of your chest flat is often called “going flat.” A procedure called aesthetic flat closure can create a smooth, flat chest contour without excess skin, fat, or other tissue. People who go flat but who want to look like they have breasts in certain situations may wear breast forms (prostheses) — an insert that you put in your bra or bathing suit or attach to your chest. 

Cryoablation is a minimally invasive procedure that uses extreme cold to freeze and kill cancer cells. It is used as an alternative to surgery for some people with breast cancer, such as those who aren’t candidates for surgery due to other health conditions or for some who have metastatic breast cancer.

People who have been diagnosed with metastatic breast cancer in some rare cases have surgery to treat an area of the body that the cancer has spread to. For instance, surgery may be done to remove metastatic breast cancer in the liver, brain, lungs, or bones. These procedures can help relieve symptoms or slow the spread of cancer.  

Prophylactic ovary removal (oophorectomy) is a preventive surgery that may be recommended to women who are at high risk of developing ovarian cancer, breast cancer, or both. It involves removing one or both ovaries and in some cases also the fallopian tubes. In women who haven’t gone through menopause, it lowers the amount of estrogen in the body, making it harder for estrogen to stimulate the development of breast cancer. In both premenopausal and postmenopausal women, it lowers the risk of ovarian cancer. 

When you meet with your doctors to discuss a surgical plan, you may have some choices to make. If you’re given the option to choose between mastectomy and lumpectomy, there are pros and cons of each that can vary depending on your individual situation. For example, opting for a lumpectomy may mean preserving more of the appearance of and sensation in the breast, but getting a mastectomy might mean that you could skip getting radiation therapy. Some people who are getting a mastectomy may have the choice of removing one breast (a single mastectomy) or both breasts (a double mastectomy). Many people who undergo surgery for breast cancer also have choices to make about whether or not to get breast reconstruction and which type.

When preparing for breast cancer surgery, it’s helpful to know what to expect before, during, and after the procedure. There are a few basic steps common to most surgeries that involve general anesthesia, such as doing preoperative tests and signing an informed consent form beforehand and having your vital signs monitored in the recovery room afterwards. Your doctor will tell you which activities to limit or avoid for a few weeks after the surgery to decrease the risk of swelling and other complications.

Connect with a supportive community of people discussing breast cancer surgery options and tips for preparing for and recovering from surgery on our discussion boards.

 

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