Breast cancer surgery options
Surgery is one part of a treatment plan for early-stage breast cancer that may also include medicines, such as chemotherapy and targeted therapy, and radiation. Surgery is a local therapy: a treatment that’s focused on a specific part of the body. In breast cancer, the goal of local therapy is to remove and control the disease in the breast and nearby lymph nodes. Surgery and other local therapies reduce the risk for local recurrence, a return of the cancer to the treated areas.
The surgery also provides your healthcare team with more information about the cancer. Whether breast cancer has traveled to the lymph nodes and, if so, how many, will be learned from this surgery. If you have been given medicine to kill cancer cells before the surgery, your team will learn if that medicine has been effective, which will help plan your future treatment. In metastatic breast cancer, or breast cancer that has spread to other parts of the body, surgery may be used to relieve symptoms such as pain.
On this page, we’ll walk you through:
- Mastectomy vs. lumpectomy
- Breast reconstruction options
- Questions to ask your surgeon
Lumpectomy is a breast-conserving surgery, allowing you to keep some or most of your breast after the cancerous area is removed. After lumpectomy, there is a risk of cancer coming back in the remaining breast tissue, so lumpectomy is often followed by radiation therapy to reduce this risk.
Lumpectomy removes the cancer from your breast along with a rim of surrounding normal tissue called the margin, sometimes called the margin of resection. Your breast surgeon works to remove a negative or “clean” margin of tissue around the cancerous tissue to reduce the risk of cancer coming back in the same area later.
Different hospitals have different standards for what they consider to be acceptable margin measurements. For example, while a margin of 2 millimeters has been found to reduce the risk of recurrence in women with DCIS who receive lumpectomy plus radiation therapy, some hospital standards say that 1 millimeter, or even less, is enough of a clean tissue margin to reduce risk of recurrence. Ask your surgeon what the measurement standards are for clean margins at your hospital.
If tissue testing results show that cancer cells are present in the margin tissue, your medical team will talk with you about options, including more surgery (re-excision) and radiation therapy to eliminate any possible remaining cancer cells in the breast tissue.
Most people who get lumpectomy do not have reconstruction, but in some cases you may get oncoplastic surgery, sometimes called partial breast reconstruction. In oncoplastic surgery, the surgeon uses plastic surgery techniques, such as breast reduction or tissue rearrangement, to reshape the breast. This can be done during surgery or after radiation.
Who can get lumpectomy?
You may be a candidate for lumpectomy if
- the tumor is 5 centimeters across or less and the cancer is in only one area of your breast
- your breast is large enough compared to the size of the tumor that your breasts still look generally balanced after surgery
- you are able and willing to get radiation therapy, which often involves daily appointments over a several-week period
- you are not pregnant, since radiation can harm an unborn baby
- you are pregnant but will not need radiation therapy right away
- you have not been diagnosed with inflammatory breast cancer, an aggressive breast cancer that does not typically form lumps
- you have not tested positive for a BRCA1, BRCA2, ATM or other genetic mutation that can increase the risk of the breast cancer coming back after lumpectomy
- you have never undergone lumpectomy or radiation therapy to the breast in the past
If the cancer is larger than 5 centimeters across but having a lumpectomy to conserve your breast is very important to you, ask your medical team whether you are a candidate for chemotherapy or hormonal therapy before surgery. This is called neoadjuvant therapy. For some women, this is an option that can shrink the tumor before surgery so that lumpectomy may still be possible.
Lumpectomy plus radiation therapy
Most people who choose lumpectomy for breast cancer removal will also need to undergo a few weeks of daily radiation therapy to reduce the risk of recurrence in the remaining breast tissue. If you’re considering lumpectomy, your surgeon may refer you to a radiation oncologist to talk about options.
The typical schedule for standard whole breast radiation treatment is once a day, 5 days a week, for 3 to 6 weeks. The last 2 weeks of treatment often include a boost, or extra treatment, to the area where the tumor was found.
Your doctor may offer you a different schedule if getting in for treatment 5 days a week is a challenge. This plan uses hypofractionated radiation, which allows you to receive a slightly higher dose of radiation over a shorter period.
Depending on the features of your tumor, your doctor may recommend partial breast radiation. External and internal partial-breast radiation is given over a shorter period, generally twice a day for 5 days, with each treatment taking up to half an hour.
Visit our radiation therapy section to learn more.
Mastectomy is surgery that removes all of the breast tissue.
In many cases, mastectomy involves removing your nipple and areola, the dark area around the nipple, because there is a risk of breast tissue being left behind under the nipple. Any breast tissue remaining after mastectomy increases the risk of cancer recurrence. While mastectomy is a more extensive surgery than lumpectomy, mastectomy has a lower risk of breast cancer recurrence than lumpectomy alone.
There are many reasons you and your medical team may decide mastectomy is a good option for you:
- personal choice
- a tumor larger than 5 centimeters
- several tumors in different parts of the breast
- tumors in the nipple area
- previous lumpectomy that did not completely remove the cancer
- previous radiation therapy in the same breast
- a diagnosis of inflammatory breast cancer
- a genetic mutation, such as BRCA1 or BRCA2, that increases the risk for breast cancer
- a strong family history of breast cancer, even if you tested negative for any known high-risk genetic mutations
- being pregnant and needing radiation therapy right away unless choosing mastectomy
- inability to have or preference to avoid radiation therapy, which usually means daily treatments for several weeks
- having a connective tissue disease that increases sensitivity to radiation therapy; examples include lupus or scleroderma
- wanting breast reconstruction on one or both breasts so the breasts cosmetically match as much as possible after the cancer is removed
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.
If you have a mastectomy, you may choose to have breast reconstruction, either at the same time as mastectomy surgery or at a later date.
Ask your surgeon to refer you to a breast reconstruction surgeon so you can understand all your options before you decide on lumpectomy or mastectomy.
Skin-sparing and nipple-sparing mastectomy
Most people are eligible for skin-sparing mastectomy, which removes all the breast tissue but leaves the breast skin intact.
A nipple-sparing mastectomy removes all the breast tissue and leaves the nipple and areola in place, usually removing breast tissue from underneath the nipple to see whether the tissue contains cancer cells. Candidates for nipple-sparing mastectomy include people who have small, early-stage tumors with no skin or nipple involvement.
Mastectomy with radiation therapy
Even though mastectomy doesn’t often require radiation therapy afterwards, there can still be situations in which radiation therapy is recommended to ensure a lower risk of recurrence. Situations that may call for radiation after mastectomy include
- cancer that was larger than 5 centimeters
- cancer cells that are found in muscle or skin after mastectomy
- cancer cells that are found in multiple lymph nodes
Most women are given the option of lumpectomy plus radiation therapy or mastectomy alone. Studies show that lumpectomy plus radiation therapy 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. Choosing mastectomy may seem like a way to prevent cancer coming back, but for most women, that is not the case. If lumpectomy is an option for you, studies have found that the chance of cancer coming back is the same whether you choose lumpectomy and radiation or mastectomy. Also, while some women who have a family history of breast cancer and a high risk of another cancer may lower that risk by having mastectomy on the breast without cancer, for most women preventive surgery will have little effect on the chances of another diagnosis. More surgery does raise the risk of complications. As you are thinking about your breast surgery choice, ask your doctor to explain how much surgery reduces the risk for a return of breast cancer.
In most cases, lumpectomy does not require reconstruction and has a shorter recovery time than mastectomy. Lumpectomy is the surgery chosen by most women with stage I and II breast cancer.
Talk to your medical team about which type of surgery is right for you. Below, we’ll share the benefits of each surgery.
Here are the main benefits of lumpectomy:
- Lumpectomy generally allows you to keep some or most of your breast, as well as the physical sensation of your breast. Mastectomy often results in breast numbness because many nerves are cut.
- Lumpectomy is less invasive than mastectomy. It’s usually an outpatient surgery that does not require an overnight hospital stay. You can often get back to regular activity in about 2 weeks. Mastectomy usually requires more recovery time.
- In most cases, lumpectomy does not require additional surgery to reconstruct the part of the breast that was removed.
Here are the main benefits of mastectomy:
- Mastectomy reduces the risk of breast cancer recurrence when compared with lumpectomy alone.
- Often, there is no requirement to undergo radiation therapy after mastectomy. For many people, knowing that they will not have to undergo weeks of daily radiation treatments feels like a significant advantage.
- If you’re at high risk for recurrence or a new breast cancer in either breast due to a genetic mutation, a double mastectomy can reduce the risk of breast cancer by at least 95 percent. If you have a strong family history of breast cancer with no known genetic mutation, a double mastectomy can reduce the risk of breast cancer by up to 90 percent.
- If you’re concerned about preserving a balanced look after breast surgery and you and your doctor believe lumpectomy may not have the cosmetic results you want, mastectomy plus breast reconstruction can offer many approaches for preserving breast symmetry.
Lymph node surgery
If you have an invasive cancer, your surgeon will need to look at one or more lymph nodes in the breast or armpit area (the axilla) to see whether they contain cancer. Lymph node surgery is usually done at the same time as your breast surgery. Looking at one or more lymph nodes can help you and your treatment team learn more about the stage of the cancer and what treatments you may need in addition to surgery.
There are two approaches to lymph node removal:
- Most of the time, surgeons use a less invasive procedure called sentinel lymph node biopsy, in which the surgeon removes the lymph node closest to the location of the cancer.
- In cancers that have traveled farther into the lymph nodes, doctors may recommend removing a group of lymph nodes from under the arm in a procedure called axillary lymph node dissection.
It’s important to know about a potential side effect of lymph node surgery called lymphedema, in which fluid can sometimes build up and cause pain and stiffness in the arm, hand, breast, and other areas. For more information about these surgeries and reducing the risk of lymphedema, visit our lymph node surgery and lymphedema pages.
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. 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.
It’s a good idea to know your reconstruction options before you decide on lumpectomy or mastectomy, because breast reconstruction can often be done at the same time as mastectomy.
If you do not rebuild your breast, you have the option to use a breast form, or prosthesis, to place in your bra after surgery to maintain symmetry. Some women choose not to have reconstructive surgery at all, for a variety of reasons, including not wanting to have more surgeries.
If you’re interested in exploring your reconstruction options, ask your breast surgeon to refer you to a breast reconstruction surgeon who can provide insights on which technique may make most sense for you and your lifestyle.
To learn more, visit our breast reconstruction section.
We know how stressful it can be to make decisions about breast cancer surgery, and that it can be hard to remember all the details coming at you during appointments. Taking a list of questions to your surgeon appointment can help. It can also help to bring someone with you who can take notes.
Here are some questions to ask at your appointment with your surgeon:
- Are you a board-certified surgeon or have you completed a breast oncology fellowship training?
- What type of surgery do you recommend for my diagnosis?
- How long have you been performing this type of surgery?
- How soon will I need surgery?
- How long will the surgery take?
- Will I need to stay overnight in the hospital?
- How will I feel after surgery?
- What are the side effects of the surgery you’re recommending?
- Will I need additional treatment following the surgery?
- Is breast reconstruction an option for me? If so, can you refer me to a breast reconstruction surgeon?
- Is there someone at the hospital I can talk to about ways to pay for surgery?
Below you can find articles, stories from others who’ve been diagnosed, and downloadable resources with more information about surgery options, decision-making, and ways to find emotional support.
- Preparing for surgery
- Getting a second opinion
- Breast reconstruction decisions
- Immediate vs. delayed reconstruction
- Breast cancer and body image
- Breast reconstruction for men
Related news & opinion
- Lumpectomy as good as mastectomy for very young women with breast cancer
- Recovering from breast cancer surgery
- Repeat surgery common after lumpectomy, especially for young women
From the blog
- What I Wish I Knew: Ask questions before surgery
- Going flat: How the questions started
- What can I do now? Breast reconstruction after inflammatory breast cancer
- Having tissue expanders for breast reconstruction: Abby Goetcheus
- My initiation into a new world
Free downloadable resources
- Coping with a New Diagnosis (PDF)
- Guide for the Newly Diagnosed (PDF)
- HER2-Positive Breast Cancer (PDF)