Surgery is a local therapy used to treat breast cancer. The goal of local therapy is to control the disease in the breast and nearby lymph nodes. It reduces the risk for local recurrence, a return of the cancer to the treated areas of the breast or lymph nodes. Surgery removes the cancer and usually some lymph nodes.
Almost everyone diagnosed with breast cancer has some surgery. Your doctor will use your initial pathology report, the results of imaging tests and physical exams to recommend the type of surgery. Ask your treatment team to explain why they recommend a certain surgery and how it will impact you.
In some cases, you may have a choice about the type of surgery. Usually, this decision involves whether you want to preserve your breast in a lumpectomy, or have the entire breast removed in a mastectomy.
Here are the most common types of breast cancer surgery.
Lumpectomy removes the tumor from your breast, along with a rim of normal tissue called the margin. When a lumpectomy is done, the goal of surgery is to remove the cancer with a negative margin, meaning the pathologist does not find cancer close to the edge of a sample of the tissue taken from your breast. Because cancer often can’t be seen with the naked eye, it can sometimes take several surgeries to remove all the cancer.
Not everyone can have a lumpectomy. In general
- the tumor needs to be less than 5 centimeters across and in only one area of your breast
- your breast must be large enough compared to the size of the tumor for the surgery to leave a good-looking result
- you must be able and willing to have radiation therapy
If you can’t have a lumpectomy because of the size or extent of the tumor but 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.
- personal choice
- several tumors in different parts of the breast
- tumors in the nipple area
- previous breast cancer in the same breast
- large tumors
- a gene mutation, such as BRCA1 or BRCA2, that increases the risk for breast cancer
Most of the time radiation is not given after mastectomy, but sometimes it is recommended. Talk with your care team about whether radiation might be needed.
Some people are eligible for skin-sparing mastectomy, removing all the breast tissue but leaving the skin, nipple and areola intact. A skin-sparing mastectomy allows a plastic surgeon to use your tissue to form the reconstructed breast with either an implant or tissue from another area of your body.
Most women are given the option of lumpectomy or mastectomy. Studies show that lumpectomy with radiation or mastectomy alone work equally well in women with tumors less than 5 centimeters across who had no cancer remaining in the healthy margins of tissue removed during lumpectomy.
When making a decision, you’ll want to weigh both the medical issues and your quality-of-life concerns. Talk to your medical team about which type of surgery is right for you.
If you have an invasive cancer, your surgeon will need to look at some of the lymph nodes in your armpit to see whether they contain cancer. This surgery is usually done at the same time as your breast surgery. It will help you and your treatment team learn more about the stage of the cancer and what treatments you may need in addition to surgery and radiation therapy.
If you have a mastectomy, you may choose to have breast reconstruction, surgery to rebuild your breast or breasts. There are many types of reconstructive surgery and you can choose to have your breast reconstructed at the time of your mastectomy or even months or years later. In the United States, about 20 to 40 percent of women who have mastectomy have breast reconstruction.
If you do not rebuild your breast, you may get a breast form, or prosthesis, to place in your bra after surgery to maintain symmetry. You may also choose not to have reconstructive surgery or use a prosthesis.
You have options, and you can take your time to decide which one makes most sense for you and your lifestyle.