Breast cancer surgery

Overview

Breast cancer surgery is a key component of breast cancer treatment that involves removing the cancer with an operation. Breast cancer surgery may be used alone or in combination with other treatments, such as chemotherapy, hormone therapy, targeted therapy and radiation therapy.

For people with a very high risk of breast cancer, breast cancer surgery may be an option to reduce the risk of future breast cancer.

Breast cancer surgery includes different procedures, such as:

• Surgery to remove the entire breast (mastectomy)
• Surgery to remove a portion of the breast tissue (lumpectomy)
• Surgery to remove nearby lymph nodes
• Surgery to reconstruct a breast after mastectomy

Which breast cancer operation is best for you depends on the size and stage of your cancer, your other treatment options, and your goals and preferences.

Why it's done

The goal of breast cancer surgery is to remove cancer cells from your breast. For those who choose breast reconstruction, a procedure to place breast implants or reconstruct a breast from your own tissue (flap surgery) may be done at the same time or in a later operation.

Breast cancer surgery is used to treat most stages of breast cancer, including:

• A high risk of breast cancer. People with a high risk of breast cancer based on a strong family history of the disease, certain noncancerous breast biopsy results or a gene mutation might consider preventive (prophylactic) mastectomy with or without immediate breast reconstruction as an option to prevent breast cancer.
• Noninvasive breast cancer. People diagnosed with ductal carcinoma in situ (DCIS) may undergo lumpectomy, which may be followed by radiation therapy, though mastectomy with or without breast reconstruction may also be an option.
• Early-stage breast cancer. Small breast cancers may be treated with lumpectomy or mastectomy with or without breast reconstruction followed by radiation and, sometimes, chemotherapy, hormone therapy or targeted therapy.
• Larger breast cancers. Larger cancers may be treated with mastectomy, though sometimes chemotherapy, hormone therapy or targeted therapy is used before surgery to make it possible to perform a lumpectomy. Additional treatment with radiation therapy, chemotherapy, hormone therapy or targeted therapy may be recommended.
• Locally advanced breast cancers. Breast cancers that are very large or have spread to several lymph nodes are often treated first with chemotherapy, hormone therapy or targeted therapy to shrink the tumor and make surgery more successful. These cancers may be removed using mastectomy or lumpectomy, followed by radiation therapy.
• Recurrent breast cancer. Breast cancer that returns after initial treatment may be removed with additional surgery. Additional treatments may be recommended.

Surgery is seldom used to treat breast cancer that spreads to other parts of the body (metastatic breast cancer).

Risks

Breast cancer surgery is a safe procedure, but it carries a small risk of complications, including:

• Bleeding
• Infection
• Collection of fluid at the operative site (seroma)
• Pain
• Permanent scarring
• Loss of or altered sensation in the chest and reconstructed breasts
• Wound healing problems
• Arm swelling (lymphedema)
• Risks related to the medicine (anesthesia) used to put you in a sleep-like state during surgery, such as confusion, muscle aches and vomiting

How you prepare

Discuss your options with a breast cancer surgeon

Your initial meeting with a breast cancer surgeon can help you understand your treatment options and what you can expect from surgery. Prepare for this meeting by creating a list of questions to ask, such as:

• Which operations are best for my particular case?
• Does each option offer the same chance for breast cancer cure?
• How much of my breast needs to be removed?
• Should my healthy breast be removed at the same time?
• How many operations will I need?
• What are my options for reconstruction?
• Can the reconstruction be started at the same time as my cancer surgery?
• How will my breast look after surgery? Will my breasts look the same?
• Can you show me pictures of other people that have undergone these procedures?
• If I choose to forgo reconstruction, what will my breast look like?
• Is surgery safe for me?
• How much time will I spend in the hospital?
• How much time will I need for recovery? When can I return to work?
• How many breast cancer surgeries have you done?
• If you had a family member in my situation, what would you recommend?

Breast cancer surgeons work closely with plastic surgeons who do breast reconstruction. If you're planning to undergo breast reconstruction, make an appointment to discuss these options, too.

What you can expect

During breast cancer surgery

Breast cancer surgery is done in a hospital. Before the procedure, you're given medicine (general anesthesia) that keeps you in a sleep-like state.

• An incision in your breast to remove cancer and surrounding tissue. How much tissue is removed will depend on whether you undergo lumpectomy to remove part of the breast tissue or mastectomy to remove all of the breast tissue. The placement and length of the incision depends on the location of the cancer within the breast.

• An assessment of the lymph nodes in your armpit. During a sentinel node biopsy, the surgeon removes a few lymph nodes into which a tumor is most likely to drain first (sentinel nodes). These are then tested for cancer. If no cancer is present, no additional lymph nodes need to be removed.

  If cancer is found, the surgeon may remove more lymph nodes or recommend radiation therapy to your lymph nodes after surgery. Sometimes both lymph node treatments are combined.

• Closure of the incision. The surgeon closes the incision with attention to your appearance. Dissolvable stitches are placed to reduce scarring.
• Reconstruction, if you choose. If you are undergoing mastectomy and choose breast reconstruction, the reconstruction is most frequently started at the time of your cancer operation. In some cases, reconstruction may be delayed and done in a separate surgery.

After breast cancer surgery

After your surgery, you can expect to:

• Be taken to a recovery room where your blood pressure, pulse and breathing are monitored
• Have a dressing (bandage) over the surgery site
• Possibly have pain, numbness and a pinching sensation in your underarm area
• Receive instructions on how to care for yourself at home, including taking care of your incision and drains, recognizing signs of infection, and understanding activity restrictions
• Talk with your health care team about when to resume wearing a bra or wearing a breast prosthesis
• Be given prescriptions for pain medication and possibly an antibiotic
• Resume your regular diet
• Shower the day after surgery

Expect to spend one night in the hospital after mastectomy if you also undergo breast reconstruction. Those undergoing mastectomy without reconstruction or lumpectomy may leave the hospital the day of surgery.