Surgery for Breast Cancer

This content has been reviewed and approved by

William J. Gradishar, MD FACP
Director, Breast Medical Oncology, Professor of Medicine
Robert H. Lurie Comprehensive Cancer Center
Northwestern University Feinberg School of Medicine

Nearly all women with breast cancer have some kind of surgery as part of their diagnosis and/or treatment. The extent of surgery for breast cancer may range from removal of only a small piece of breast tissue to removal of one or both breasts, including the lymph nodes in your armpit (axilla).

Surgery has several purposes:

• To obtain a tissue sample for making an accurate diagnosis
• To determine the stage of your cancer and whether you need additional treatment
• To treat the cancer locally

Surgery is considered a local treatment. That means it can remove cancer in or near your breast, but it cannot treat cancer that has spread to other parts of your body. Cancer cells that have spread are called micrometastases. You need systemic treatment to get rid of them. That is treatment that can get at cancer anywhere in your body. Some examples of systemic treatment are chemotherapy and hormonal therapy.

The information your doctor acquires from doing surgery and from the other tests helps tell how likely it is that your cancer has spread and whether you need systemic treatment.

How is surgery used in breast cancer treatment?

Surgery is used to remove as much of the cancer as possible and is the primary treatment for breast cancer. Today, women have many surgical options and choices. The type of surgery performed depends upon the:

• Size and location of the breast lump or tumor
• Type and stage of the breast cancer (if the cancer has spread within the breast or has Spread outside of the breast to the lymph nodes, or to other parts of the body)
• Size of the breast
• The patient's preference

There are several types of breast surgery. Your physician can explain the benefits and risks of each type, in addition to answering any questions or concerns you may have prior to surgery.

Questions to Ask Your Physician Before Surgery

• Which type of surgery do you recommend for me? Why?
• Where will the incision be located and how much of the breast tissue will be removed?
• Will any lymph nodes be removed?
• Will I be able to have breast reconstruction if I have a mastectomy?
• Do you recommend breast reconstruction at the same time of the mastectomy surgery or at a later date?
• Will additional treatment, such as radiation or chemotherapy, be required following surgery?
• What type of follow-up care is needed?
• How long will it be before I resume my normal activities?

What are some of the different types of breast cancer surgery?

There are two types of breast conservation (tissue-sparing) surgery. These include a lumpectomy and a partial (segmental) mastectomy.
 
A lumpectomy is the removal of the cancer and a portion of normal tissue around the breast cancer lump. The surgeon may also remove some of the lymph nodes under the arm to determine if the cancer has spread. Often, breast cancer spreads to these lymph nodes, thereby entering the lymphatic system and allowing the cancer to spread to other parts of the body.

Radiation therapy is often administered following a lumpectomy to destroy cancer cells that may not have been removed during the lumpectomy procedure. If you have a mastectomy, but do not have breast reconstruction, you may be interested in learning more about breast prostheses, also called breast forms. For more information regarding this, please see Prostheses After Mastectomy or Lumpectomy.

If you are having plastic surgery for breast reconstruction and would like more information please see Plastic Surgery for Breast Reconstruction.
 

A partial (segmental) mastectomy involves the removal of the cancer and a larger portion of the normal breast tissue around the breast cancer. The surgeon may also remove the lining over the chest muscles below the tumor and some of the lymph nodes under the arm.

Mastectomy as a Non-Breast-Conserving Procedure

If a woman does not choose a breast-conserving surgery, she may choose a mastectomy (removal of the breast). The physician may recommend a mastectomy under the following circumstances (among others):

• If the cancer has spread to other parts of the breast tissue or has spread to the lymph nodes under the arm
• If the breast is very small and a lumpectomy would require removing additional breast tissue, resulting in a very deformed breast

There are three types of mastectomy. Your physician can explain the benefits and risks of each type:

• Total (or simple) mastectomy
• Modified radical mastectomy
• Radical mastectomy

During a total (or simple) mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and most of the overlying skin) and may also remove some of the lymph nodes under the arm, also called the axillary lymph glands. The bean-shaped lymph nodes under the arm drain the lymphatic vessels from the upper arms, the majority of the breast, the neck, and the underarm regions. Often, breast cancer spreads to these lymph nodes, thereby entering the lymphatic system allowing the cancer to spread to other parts of the body.

If you have a mastectomy, but do not have breast reconstruction, you may be interested in learning more about breast prostheses, also called breast forms. For more information, see Prostheses After Mastectomy or Lumpectomy.

During a modified radical mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), some of the lymph nodes under the arm (also called the axillary lymph glands), and the lining over the chest muscles. In some cases, part of the chest wall muscle is also removed.

During a radical mastectomy, the surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), the lymph nodes under the arm, also called the axillary lymph glands, and the chest muscles. For many years, this was the standard operation. However, today, a radical mastectomy is rarely performed and is generally only recommended when the breast cancer has spread to the chest muscles.