Breast Cancer Surgery
Overview
Breast cancer surgery treats breast cancer by removing the cancer through an operation. Doctors often combine surgery with other treatments, such as radiation, chemotherapy, hormone therapy, or targeted therapy. Several operations are available to treat breast cancer, including breast-conserving surgery, complete removal of breast tissue, lymph node procedures, and breast reconstruction.
Healthcare teams choose the best operation based on the size and stage of the cancer, the person’s health, treatment options, and personal wishes. Preferences and medical advice both play a part in the choice.
Types of Breast Cancer Surgery
Several surgical options exist, depending on the stage of the cancer, tumor size, and patient preferences. Each type aims to remove the cancer while considering appearance and long-term health.
- Lumpectomy: Removes only the tumor and a small margin of healthy tissue. This procedure is breast-conserving and often followed by radiation therapy.
- Simple Mastectomy: Removes all breast tissue but does not take out lymph nodes or chest muscles. Sometimes both breasts are removed.
- Modified Radical Mastectomy: Removes the entire breast along with some of the lymph nodes under the arm, but not the chest wall muscles.
- Skin-Sparing Mastectomy: Removes breast tissue but leaves most of the skin intact to support breast reconstruction.
- Nipple-Sparing Mastectomy: Preserves the nipple and areola while removing the underlying breast tissue.
- Reconstructive Surgery: Rebuilds the breast shape after mastectomy using implants or tissue from another part of the body.
Why This Procedure Is Performed
Doctors often remove cancer cells from the breast with surgery. The aim is to get rid of the tumor while protecting as much healthy tissue as possible. Surgery can help in different situations, such as:
Noninvasive Types: When cancer is still located in the milk ducts and has not spread, doctors may use surgery as the first and sometimes only step.
Cases in Early Stages: If cancer is found early—before it spreads—removing the tumor may give the best chance of a cure. Other treatments, such as medication or radiation, may follow.
Locally Advanced Disease: If the tumor has grown larger or reached the skin or muscle, doctors may perform surgery after other treatments like chemotherapy or targeted therapy.
When Cancer Returns: If cancer comes back in the breast after previous treatment, doctors may remove the new growth through surgery.
Note: If cancer has spread far from the breast, doctors usually do not use surgery as the main treatment.
| Type of Cancer | Is Surgery an Option? | Other Treatments Needed? |
|---|---|---|
| Noninvasive | Usually | Sometimes |
| Early-stage | Usually | Often |
| Locally advanced | Sometimes, with other treatments | Yes |
| Cancer that has spread widely | Rarely | Yes |
Reconstruction Options: Some people choose breast reconstruction during or after surgery to restore the natural shape.
Preventing Breast Cancer Before It Begins
For people at high risk, surgery can help lower the risk of getting cancer. This often involves removing most breast tissue before cancer develops. Doctors sometimes call this preventive surgery risk-reducing or prophylactic mastectomy. Considerations for surgery may include:
- Family members who had breast cancer
- Inherited mutations that raise the risk
- Personal preferences about cancer prevention
Taking this step is a significant decision and should involve a detailed conversation with a medical specialist.
Possible Complications
Breast cancer surgery is generally safe, but complications can happen. Common risks soon after the procedure include:
- Bleeding
- Seroma (fluid buildup at the surgical site)
- Infection
- Pain
- Poor healing of the wound
- Side effects from anesthesia such as confusion, nausea, or vomiting
Other risks may appear during recovery, especially if lymph nodes are removed. These include:
- Lymphedema (swelling of the arm)
- Changes in body image or appearance
- Numbness or sensitivity changes in the chest or breast area
- Long-lasting discomfort or pain
| Complication | When It Can Happen |
|---|---|
| Bleeding | Right after surgery |
| Seroma | Soon after surgery |
| Lymphedema | During recovery |
| Infection | Short or long term |
How You Can Get Ready
Before surgery, meet with a breast cancer surgeon and bring a written list of questions. This can make the conversation easier and ensures all your concerns are addressed. Topics to discuss might include:
| Surgery Questions | Breast Reconstruction | Risks and Recovery |
|---|---|---|
| Options for surgery types | Options for rebuilding a breast | How safe surgery is for you |
| What steps may guide your choice | If reconstruction can start soon | Hospital stay duration |
| How much tissue will be removed | How many surgeries are needed | Recovery time expectations |
| How your breast may look | Activity limits after surgery |
Ask how your breasts might look after any procedure, especially if you are interested in reconstruction or want to know the results of not having it.
Breast cancer surgeons work with reconstructive specialists. If planning for breast reconstruction, set up an appointment with a plastic surgeon as well.
Tip: Write questions in a notebook or on your phone so you don’t forget them during your visit. Bring someone you trust to help remember the answers and support you while making choices.
What You Can Expect
What Happens in the Operating Room
Breast cancer surgery usually takes place in a hospital setting under general anesthesia, so the patient is asleep and does not feel pain. The surgeon makes a careful cut in the breast to take out the cancer. The exact spot and length of this cut depend on where the tumor is found and the type of surgery chosen.
- Nipple-Sparing Mastectomy: The surgeon removes cancerous breast tissue but keeps all of the skin, the nipple, and the areola when possible. This can offer a more natural appearance after surgery.
- Lumpectomy: The surgeon removes only the lump and a small area of healthy tissue around it.
- Mastectomy with Breast Reconstruction: The surgical team can reconstruct the breast during the same operation to restore its shape. They may use a pre-pectoral approach, placing the implant in front of the chest muscle instead of behind it, which can mean less pain and a more natural shape.
Surgeons often remove lymph nodes as part of breast cancer surgery. They may perform a sentinel lymph node biopsy, removing only a few key lymph nodes in the underarm area to check if cancer has spread. In some cases, they perform a more extensive removal, called an axillary lymph node dissection, if they find cancer in the sentinel nodes.
Once the surgeon removes all needed tissue and lymph nodes (if required), they stitch the area closed. If breast reconstruction is planned, the plastic surgeon joins the team at this point. The team may place implants, and with the pre-pectoral method, the operation can avoid disturbing the chest muscles, often leading to faster recovery and less discomfort after surgery.
Typical steps during surgery:
| Step | Description |
|---|---|
| Anesthesia | The patient is given medication so they are asleep and pain-free. |
| Incision | A surgeon makes a cut to access and remove a tumor or breast tissue. |
| Lymph node procedure | Sentinel lymph node biopsy or axillary dissection, if needed. |
| Breast reconstruction | May begin during the same procedure if chosen. |
| Closing incision | Stitches are used to close the surgical area. |
After the surgery ends, the patient moves to a recovery area while waking up from anesthesia.
What Usually Happens After the Procedure
After surgery, patients typically go to a recovery room, where staff monitor vital signs like blood pressure, heart rate, and breathing. A bandage covers the surgical site to protect it. Some patients may have drainage tubes to remove any extra fluid from the area. Common experiences after surgery include:
- Pain where the surgery was performed.
- Numbness or tingling, especially near the underarm if lymph nodes were removed.
- A sensation of tightness or pinching.
Most people get detailed instructions on how to care for the incision and any drains when they go home. Nurses and doctors will advise on how to spot signs of infection like unusual redness, swelling, or fever.
Post-Surgery Tips
- Keep the incision area clean and dry as directed.
- Take any medicines as prescribed to manage pain or prevent infection. Over-the-counter medications like acetaminophen or ibuprofen can help manage discomfort after surgery. In some cases, doctors may prescribe short-term opioid pain relievers if stronger medication is needed. Always follow instructions carefully and talk with your care team about managing side effects.
- Avoid heavy lifting or strenuous activity until approved by the surgical team.
- Watch for signs of infection and call a healthcare provider if there are concerns.
Many patients can go home the same day as their operation, but sometimes a short hospital stay may be needed. Patients are also told about when they can return to their normal diet and activities. In most cases, they can shower within a day or two, but specific guidance will depend on the type of surgery and the surgeon’s recommendations.
If breast reconstruction was done, follow-up appointments are usually arranged to monitor healing and discuss any further steps. Some patients may need several visits or even additional procedures to complete the reconstruction process. Follow all instructions from the healthcare team closely to support the best healing and outcome.
Surgical Outcomes
After breast cancer surgery, the main focus is to check if all cancerous tissue was successfully taken out. Results can be shared during a follow-up visit or sometimes by phone or letter, depending on each patient’s care plan.
| Situation | Possible Actions |
|---|---|
| All cancer removed | Watchful follow-up |
| More tissue needs removing | Additional surgery |
| Considering reconstruction | Multiple operations possible |
Further treatment is also common. These options can include:
- Chemotherapy
- Radiation therapy
- Hormone therapy
- Targeted therapy
When these treatments begin depends on the type and stage of the cancer. Patients should talk to their care team to know what will happen next and when to expect more information.
