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Surgery

Updated September 27, 2010

Your doctor will use your initial pathology report, the results of imaging tests and physical exams to make recommendations about surgery. Ask your treatment team to explain the reasons why they recommend a certain surgery and how it will impact you.

In some cases, you may have a choice about surgery. Your main decision then is whether you want to try to preserve your healthy breast tissue or instead have the entire breast removed. In this section, learn about the most common types of breast cancer surgery.

Lumpectomy

Mastectomy

Lymph Node Biopsy

Breast Reconstruction

Lumpectomy (Breast-Conserving Surgery)

If you choose breast conservation surgery, the surgeon performs a lumpectomy (also called a partial mastectomy or segmental excision). This is followed by radiation treatment to the remaining breast tissue.

Lumpectomy removes the tumor from your breast, along with a rim of normal tissue, called the margin.

The surgery must remove all the cancer from your breast. Because cancer often cannot be seen, sometimes it may take two or three surgeries to remove it all.

Not everyone can have breast conservation surgery. In general, the tumor needs to be less than five centimeters across. It must also be in only one area of your breast. Your breast must be large enough for the surgery to leave a good-looking result, and you must be able and willing to get radiation therapy.

If you cannot have breast conservation because of the size or extent of the tumor and you wish to do so, you may be able to get chemotherapy or hormonal therapy before surgery to shrink the tumor. This is called neoadjuvant therapy.

Mastectomy

In some cases, the surgeon may recommend a mastectomy, removing the entire breast. This is done for a variety of reasons. Perhaps you have several tumors in different parts of the breast or in the area of your nipple. Previous breast cancer in the same breast, large tumors or aggressive tumors warrant mastectomy as well.

With early-stage breast cancer, you probably will not need radiation therapy after mastectomy, since all breast tissue has been removed. But sometimes radiation is still needed, so talk with your treatment team. If you have a mastectomy, you may choose to have breast reconstruction, either at the time of surgery or later on.

Lumpectomy or Mastectomy?

Some women have the choice of lumpectomy or mastectomy. Studies show that lumpectomy followed by radiation therapy works as effectively as mastectomy in treating early-stage breast cancers.

Talk to your medical team about what type of surgery may be right for you.

Other Breast Cancer Surgeries

Lymph Node Biopsy

If you have an invasive cancer, your surgeon will need to look at the lymph nodes under your arms. These lymph nodes, also called axillary nodes, may contain cancer. This surgery, called lymph node biopsy, will be done at the same time as your breast surgery. This information will help you and your treatment team learn the stage of the cancer. Then you can figure out what treatment you might need in addition to surgery and radiation.

Your doctor will examine your lymph nodes. If the tumor is less than three centimeters across and the lymph nodes underneath your arm are not enlarged, then you should have a sentinel lymph node biopsy at the time of your surgery.

In this surgery, the doctor removes the sentinel nodes, the first axillary lymph nodes that normally drain fluid from the breast. If cancer travels away from the breast, sentinel nodes are the first place it travels. There are many ways to find the sentinel nodes. Your doctors should describe their method to you.

The surgeon will test the sentinel nodes to see whether they contain cancer. If they do not, no more nodes will be removed. If they do, your surgeon may remove more axillary lymph nodes. This could happen at the time of your sentinel node biopsy or at another surgery.

If the tumor in your breast is larger than three centimeters across or your lymph nodes are enlarged before your breast biopsy, you will not have a sentinel lymph node biopsy. Instead, you will have an axillary lymph node dissection. This involves removal of most of the lymph nodes under the arm. Axillary dissection, a more extensive surgery, has a higher risk for long-term side effects, including lymphedema.

Before surgery, ask whether you will have a sentinel lymph node biopsy or axillary dissection. Ask why the surgeon recommends one over the other, and ask about the risks for short- and long-term side effects.

Breast Reconstruction Surgery

If your surgeon recommends a mastectomy, your entire breast will be removed. After this procedure, you have options to reconstruct your breast. You may choose to pursue them or not. Every case is different. Remember there is no “right answer,” just the best one for you.

There are many types of reconstructive surgery. You can choose to have your breast rebuilt at the time of your mastectomy, or even months or years later.

Another option that does not involve a surgical procedure is a prosthesis, an artificial breast form that fits into your bra. A prosthesis helps you keep a breast shape when you wear clothes.

Or you may choose not to have reconstructive surgery or use a prosthesis.

You have options, and you can take your time to decide. Some choices may make sense for you and your lifestyle, and some may not.

Read about the providers who helped us write this page in our Guide for the Newly Diagnosed.

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