Surgery for Breast Cancer

Most women with breast cancer have some type of surgery as part of their treatment. There are different types of breast surgery, and it may be done for different reasons, depending on the situation. For example, surgery may be done to:

• Remove as much of the cancer as possible (breast-conserving surgery or mastectomy)
• Find out whether the cancer has spread to the lymph nodes under the arm (sentinel lymph node biopsy or axillary lymph node dissection)
• Restore the breast’s shape after the cancer is removed (breast reconstruction)
• Relieve symptoms of advanced cancer

Surgery to remove breast cancer

There are two main types of surgery to remove breast cancer:

Breast-conserving surgery (also called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy) is a surgery in which only the part of the breast containing the cancer is removed. The goal is to remove the cancer as well as some surrounding normal tissue. How much breast is removed depends on where and how big the tumor is, as well as other factors.

Mastectomy is a surgery in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomies. Some women may also get a double mastectomy, in which both breasts are removed.

Choosing between breast-conserving surgery and mastectomy

Many women with early-stage cancers can choose between breast-conserving surgery (BCS) and mastectomy. The main advantage of BCS is that a woman keeps most of her breast. But in most cases she will also need radiation. Women who have mastectomy for early-stage cancers are less likely to need radiation.

For some women, mastectomy may be a better option, because of the type of breast cancer, the large size of the tumor, previous treatment with radiation, or certain other factors.

Some women might worry that having a less extensive surgery might raise their risk of the cancer coming back. But studies following thousands of women for more than 20 years show that when BCS is done with radiation, survival is the same as having a mastectomy in people who are candidates for both types of surgery.

Surgery to remove nearby lymph nodes

To find out if the breast cancer has spread to underarm (axillary) lymph nodes, one or more of these lymph nodes will be removed and looked at in the lab. This is an important part of figuring out the stage (extent) of the cancer. Lymph nodes may be removed either as part of the surgery to remove the breast cancer or as a separate operation.

The two main types of surgery to remove lymph nodes are:

Sentinel lymph node biopsy (SLNB) is a procedure in which the surgeon removes only the lymph node(s) under the arm where the cancer would likely spread first. Removing only one or a few lymph nodes lowers the risk of side effects from the surgery, such as arm swelling that is also known as lymphedema.

Axillary lymph node dissection (ALND) is a procedure in which the surgeon removes many (usually less than 20) underarm lymph nodes. ALND is not done as often as it was in the past, but it might still be the best way to look at the lymph nodes in some situations.

Breast reconstruction after surgery

Many woman having surgery for breast cancer might have the option of breast reconstruction. A woman having a mastectomy might want to consider having the breast mound rebuilt to restore the breast’s appearance after surgery. In some breast-conserving surgeries, a woman may consider having fat grafted into the affected breast to correct any dimples left from the surgery. The options will depend on each woman’s situation

There are several types of reconstructive surgery, but your options may depend on your medical situation and personal preferences. You may have a choice between having breast reconstruction at the same time as the breast cancer surgery (immediate reconstruction) or at a later time (delayed reconstruction).

If you are thinking about having reconstructive surgery, it’s a good idea to discuss it with your breast surgeon and a plastic surgeon before your mastectomy or BCS. This gives the surgical team time to plan out the treatment options that might be best for you, even if you wait and have the reconstructive surgery later.

Surgery for advanced breast cancer

Although surgery is very unlikely to cure breast cancer that has spread to other parts of the body, it can still be helpful in some situations, either as a way to slow the spread of the cancer, or to help prevent or relieve symptoms from it. For example, surgery might be used:

• When the breast tumor is causing an open wound in the breast (or chest)
• To treat a small number of areas of cancer spread (metastases) in a certain part of the body, such as the brain
• When an area of cancer spread is pressing on the spinal cord
• To treat a blockage in the liver
• To provide relief of pain or other symptoms