Breast Cancer Surgery Options

Several factors go into determining which one is most appropriate

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Surgery is a commonly used intervention when treating breast cancer. There are two main types of surgery for breast cancer: a lumpectomy and a mastectomy. The goal of these surgeries is to remove the tumor so that it won't reappear later in your breast (recur) or spread to other parts of your body (metastasize). The recommended breast cancer surgery for you depends on several factors, including the type of cancer you have, your tumor's characteristics, and your medical history.

Your healthcare provider may recommend an additional procedure be done alongside your cancer surgery, such as sentinel lymph node biopsy, axillary lymph node dissection, or full axillary lymph node dissection. They're sometimes done separately from cancer-removal surgery, as well.

This article will review the types of breast cancer surgery.

Lumpectomy

A lumpectomy can also be referred to as breast conservation surgery and is commonly used for early-stage breast cancer. It's sometimes also done to remove precancerous or noncancerous breast changes.

what to expect during a lumpectomy
 Verywell / JR Bee

During a lumpectomy, the surgeon removes the cancerous tumor along with a margin of healthy tissue around it. Additionally, the surgeon may remove lymph nodes close to the cancer and check for cancer cells.

Depending on how much tissue is removed, your breast may not change much in size or shape. Following the surgery, scar tissue can form in this area, which may change the texture of your breast. This scarred area will show up on future mammograms as looking different from the unaffected breast tissue.

A scar will be present on the skin where your incision was made. The surgeon can instruct you on how to take care of the incision and promote healing.

Mastectomy

A mastectomy may be needed when the tumor in the breast is large or if there are multiple tumors present.  Additionally, mastectomy may be recommended in cases of small or early-stage cancer if other factors are involved, such as when it's a recurrence of cancer or if there's a strong family history of the disease.

There are several types of mastectomy. What type you need is based on your specific prognosis.

Simple Mastectomy

During a simple mastectomy, all of the breast tissue is removed, including the skin, nipple, areola, as well as the covering of the muscle underneath the breast tissue.

Modified Radical Mastectomy

In a modified radical mastectomy, a simple mastectomy is combined with the removal of all of the lymph nodes under the arm of the side of the affected breast.

Radical Mastectomy

During a radical mastectomy, the entire breast is removed, along with all of the lymph nodes under the arm. The muscles in the chest that sit under the breast are removed as well.

Skin-Sparing Mastectomy

With a skin-sparing mastectomy, all of the breast tissue, except the skin, is removed. The nipple and areola are removed as well. To fill the space under the skin, an implant is placed in the cavity. Sometimes tissue from other areas of the body is used to replace the missing breast tissue.

Nipple-Sparing Mastectomy

A nipple-sparing mastectomy is similar to a skin-sparing mastectomy, but the nipple and areola are left in place. The breast is reconstructed with either an implant or other tissue.

There is a risk that due to changes after surgery, the nipple and areola may not get enough blood supply to keep feeding the tissue with oxygenated blood. If this happens, the nipple may need to be removed later.

Breast Reconstruction After Mastectomy

If you have an immediate breast reconstruction, your surgeon will not remove much skin during your mastectomy, so that it can be closed over the reconstructed breast. If the nipple is removed, a nipple and areola may be able to be constructed from your remaining skin.

Making Your Choice

If you need breast cancer surgery, you may have multiple options to choose from in terms of surgery. Your surgeon will review all of the possible surgeries that may be appropriate for you.

Determining which surgical procedure is best for you depends on several factors, including:

  • The type, size, and stage of the cancer
  • The size of your breast
  • Where the cancer is located in your breast
  • Whether the cancer has spread
  • Risk of recurrence
  • Family history of breast cancer
  • Additional treatments you may need in the future
  • Cosmetic preferences
  • Recovery time

Moving Ahead

Surgery can cause some fear and anxiety, but it's important to know that breast cancer surgeries are very successful. A study published in 2018 found a low risk of local recurrence (2.3%) and distant metastasis (5.7%). Meanwhile, the five-year survival rate was high (98.6%).

Reading up on each type of surgery can help you understand the benefits and risks, and can help you discuss the options with your surgeon so you can make a more informed choice. 

Finding a Good Surgeon

If you need help finding a surgeon, ask your healthcare provider for a recommendation. If you have an oncologist, they should also be able to refer you to surgeons who are experienced in breast surgery.

In addition to excellent surgical skills, other qualities to a surgeon are important. These can include good listening skills, the ability to answer your questions, and having patience for your questions.

Health Insurance

Check with your health insurance company to see whether the surgeon you're considering and the hospital or surgical center where they work is in-network.

While you’re checking on your insurance coverage, you may also want to find out which anesthesia firms work with the hospital. Your surgeon, the hospital, and the anesthesiologist will bill you and/or your health insurance separately. Doing your homework first can help prevent any financial surprises after surgery.

Summary

There are multiple options for breast surgery when needed for breast cancer treatment. Depending on factors such as tumor size and grade, the surgeon will make recommendations on the type of surgery that should be done.

Options for surgery include partial mastectomy, in which only part of the breast is removed. The other option is mastectomy, in which all of the breast is removed.

A Word From Verywell

In considering these procedures, it is important that you select the one that you are most comfortable with. Consider getting a second opinion no matter which way you're leaning. You may have more choices for breast cancer management. Learn how to advocate for yourself to get the best care possible.

Frequently Asked Questions

  • What is the most common surgery for breast cancer?

    For earlier stage cancers, such as stage I or II, the most common breast surgery is a partial mastectomy. For a later stage III breast cancer, a mastectomy is most commonly used.

  • Does your choice of surgery affect whether you will need chemotherapy or hormone therapy?

    The choice of surgery doesn't often affect whether or not chemotherapy is needed. However, it may change the need for radiation therapy or not. If a mastectomy is done, radiation may not be needed. But if a partial mastectomy is done, radiation may be given.

  • Will your choice of surgery affect the chances of cancer coming back?

    Not likely. Studies have shown that in early-stage breast cancer, the risk of cancer recurrence between mastectomy vs partial mastectomy with radiation is similar.

  • Which is better: chemotherapy or surgery?

    These are very different treatments and cannot be compared. There are many scenarios in which one of them may be better needed than the other in certain patients.

  • When is surgery not an option for breast cancer?

    Different types of surgery may not be an option if the tumor is very large or close to the surface of the skin. Furthermore, surgery may not be a good option if the cancer has spread to areas outside of the breast and become metastatic.

Originally written by
Pam Stephan
Pam Stephan is a breast cancer survivor.
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7 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
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