Breast Cancer Surgery Options

Several factors go into determining which one is most appropriate

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woman being prepared for surgery
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If breast cancer surgery is on the table as part of your treatment plan, the three options—lumpectomy, quadrantectomy, and mastectomy—are worth getting to know more about. All of these options aim 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 best breast cancer surgery for you depends on several factors, the most important being the type of cancer you have, your tumor's characteristics, and your medical history.

The three types of breast cancer surgeries are:

  • Lumpectomy: Removal of the cancerous tumor along with a margin of surrounding tissue.
  • Quadrantectomy: Removal of the tumor and a larger area of nearby tissue.
  • Mastectomy: Removal of all of the breast tissue on one or both sides. In some cases, part of the chest wall muscle may be removed as well.

Your doctor 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.

If your cancer is caught early and the tumor is small and non-invasive, you have the most choices to consider. Later diagnosis, larger or more invasive tumors, and recurrences may mean less aggressive approaches aren't appropriate.

Lumpectomy

Lumpectomy is a common recommendation for small tumors and early-stage breast cancer. It's sometimes also done to remove pre-cancerous or non-cancerous breast abnormalities.

A lumpectomy is a minimally invasive surgery that is also referred to as a "wide local excision." If you hear someone talking about a "breast-conserving procedure," this is probably what they're talking about. 

Rather than removing the entire breast, as in a mastectomy, the surgeon removes the lump itself and a margin of tissue around it. Since a tumor typically has bumpy or spiky parts that may be trying to branch out and spread, the surgeon will want to be sure that there is no evidence of tumor left in the tissue after the procedure is complete. This, what's known as getting clear margins, is of the utmost importance when a lumpectomy is performed.

Information from your mammogram or ultrasound report is used to advise this.

Depending on how much tissue is removed, your breast may not drastically change in terms of size and shape. Your body will generate some scar tissue in the surgical area, which may fill in the place where the lump was. This will change the texture of your breast somewhat, though, and this area will show up on future mammograms as different from the undisturbed breast tissue.

You will have a scar on the skin where your incision was made, but with good care, it can fade into a small line that is just a bit lighter than the surrounding skin. Ask your surgeon how you can take the best care of the incision and promote healing.

Quadrantectomy

Larger tumors may require a quadrantectomy (a.k.a. partial mastectomy). This kind of surgery removes one-quarter of the breast and is also considered a breast-conserving procedure. Your surgeon will remove the tumor and 2 to 3 centimeters (1 to 1½ inches) of breast tissue surrounding it to be sure that the margins around the tumor are clear of cancer.

Skin that is lying over that quarter of your breast will also be removed and some of the muscle of the chest wall, beneath the tumor, may also need to be taken out. The lymph nodes that are closest to the tumor will be removed and tested for cancer cells, as will the skin and the tissue around the tumor.

A quadrantectomy will result in a change of size and shape of your breast, and after you recover from surgery; you may or may not choose to use some additional padding in your bra to even out your appearance. You may also wish to have a plastic surgeon remodel the breast into a smaller size with a natural shape.

This type of procedure is most effective when it's done before any other cancer treatments, such as radiation or chemotherapy.

Mastectomy

If the tumor is larger or is invasive, a mastectomy may be necessary. 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.

This kind of surgery removes as much of the breast tissue as possible. Two types of mastectomy are:

  • The modified radical mastectomy, in which the surgeon removes all of the breast tissue on one or both sides, depending on whether you have a unilateral (one breast) or bilateral (both breasts) procedure. The breast skin and nipple may or may not be removed, depending on whether your surgeon is comfortable performing this procedure and if your tumor is in a location that makes this possible. An axillary lymph node dissection may be done if a sentinel node biopsy determines that cancer is present in the lymph nodes.
  • A total or Halstead mastectomy removes the nipple and areola, the breast skin and tissue, and may also remove a part of the chest wall muscle underneath the breast. The lymph nodes in the armpit area (axilla) are also removed and tested for cancer.

If you don't have breast reconstruction or plastic surgery after a mastectomy, you'll have a slightly curved scar at the incision and the breast area will be flat. Taking good care of the scar will result in a fine light line over time. You can use a prosthetic bra, which has pockets to hold a breast prosthesis, if you like, to balance your appearance.

Breast Reconstruction After Mastectomy

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

Making Your Choice

If you need breast cancer surgery, you may have some choice about which procedure to have, depending on the specifics of your case. Consider these factors as you learn about the different options:

  • The size of your tumor, it's grade, and your lymph node status
  • The benefits of each surgery with regard to the chance of recurrence in the breast
  • The risks associated with each surgery
  • Treatment that you will be having in addition to surgery, including chemotherapy, hormonal therapy, and radiation
  • The possibility that you could have hereditary breast cancer
  • Whether your surgery will be performed by a general surgeon or a breast-surgery specialist
  • What cosmetic result to expect from each procedure, which can depend on both the size of your tumor and where in your breast it's located
  • The length of recovery time, which determines the impact on your life and how much time you'll need to take off of work

Moving Ahead

Surgery can be scary, so it's important to note that breast cancer surgeries tend to be very successful. A large study published in 2018 found extremely small amounts of local recurrence (2.3 percent) and distant metastasis (5.7 percent.) Meanwhile, the five-year survival rate was high (98.6 percent).

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

Finding a Good Surgeon

If you have never had surgery or don’t know a surgeon to see about this, ask your family doctor or nurse practitioner to recommend one. If you have an oncologist, he or she should also be able to refer you to surgeons who have done these kinds of breast cancer surgeries.

Finding a surgeon with a lot of experience in breast surgery and who has a good reputation is, obviously, very beneficial. But also consider qualities like good listening skills, an ability to clearly answer your questions, and patience.

Health Insurance

Check with your health insurance company, if you have one, to see whether the surgeon you're considering and the hospital or surgical center where he or she works is in network. Also, before you agree to any procedures, check with your surgeon’s staff to see if they can work with your health insurance company to get the best benefits for you.

While you’re checking on your insurance coverage, find out which anesthesia firms work with the hospital. Be sure those are covered by your health insurance as well. Your surgeon, the hospital, and the anesthesiologist will all bill you and/or your health insurance separately. Doing your homework first can help prevent any financial surprises after your surgery.

A Word From Verywell

In considering these procedures, it is important that you choose one that is not only appropriate for your case, but that you are most comfortable with. If family or friends don't agree, calmly thank them for their opinion and let them know that you are making the decision that you feel is best for you. 

Consider getting a second opinion no matter which way you're leaning. You have many more choices than even a few years ago when it comes to breast cancer management, but this also means there are more decisions to make. Learn how to advocate for yourself as a cancer patient to get the best care possible.

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