Breast Cancer Surgery Options and Differences

Comparing Types of Breast Cancer Surgery

woman being prepared for surgery
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What are the different kinds of surgery offered for breast cancer, and how can you compare them?

Preventing cancer recurrence is the top priority when it comes to breast cancer surgery. The goal is to remove the tumor so that it won't reappear later in your breast, or spread to and appear in other parts of your body. 

Factors to Consider in Choosing Breast Cancer Surgery

If you need breast cancer surgery, you have some choice about which procedure to have. Consider these factors as you learn about the different options:

  • The size of your tumor, it's grade, and your lymph node status (if you know it)
  • Who will do your surgery, 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 time you wish to take off of work or off of life as some procedures have longer recovery times than others
  • The risks associated with each surgery
  • The benefits of each surgery with regard to the chance of local recurrence (recurrence in the breast)
  • Treatment that you will be having in addition to surgery, including chemotherapy and hormonal therapy
  • The need to have radiation therapy
  • The possibility that you could have hereditary breast cancer

Types of Breast Cancer Surgeries

The three surgical procedures used for breast cancer are:

  • Lumpectomy - Removal of the cancerous tumor along with a margin of surrounding tissue.
  • Quadrantectomy - Removal of the cancer 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.

Comparing Breast Cancer Surgeries and Making a Choice

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. 

When done reading about all of the options below, check out this list of 10 questions to consider when deciding between a mastectomy and lumpectomy.

Lumpectomy for Breast Cancer

A lumpectomy is a minimally invasive surgery that is also referred to as a "wide local excision." If you hear talk about a "breast-conserving procedure," this is likely the procedure that is being explained. Your surgeon’s task will be to remove the lump itself and a margin of tissue that surrounds the lump. Your surgeon will work by feel and on information that is included in your mammogram or ultrasound report.

Getting "clear margins" is of the utmost importance when a lumpectomy procedure is performed, and why an area of tissue surrounding the tumor is also removed. Since a tumor typically has bumpy or spiculated surfaces which may be trying to branch out and spread, the surgeon will want to be sure that when the tumor is removed there is no evidence of tumor left in the tissue. The tentacles or outer bumps of cancer are what give cancer its name, coming from the word for crab.

Depending on how much tissue is removed, you may not need a prosthesis, or extra padding in your bra, after you’ve recovered from a lumpectomy. Your body will generate some scar tissue in the surgery area, which will fill in the place where the lump was. This will change the texture of your breast somewhat, 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, this will fade into a small line that is just a bit lighter than the surrounding skin. Ask your surgeon or family doctor how you can take the best care of the incision and promote healing.

Quadrantectomy for Breast Cancer

Larger tumors may require a quadrantectomy. This kind of surgery removes one-quarter of the breast and is considered a breast-conserving procedure. It's also known as a partial mastectomy. Your surgeon will remove the tumor and 2-3 centimeters (1 –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 best done before any other cancer treatments, such as radiation or chemotherapy, are done.

Mastectomy for Breast Cancer

If the tumor is larger or is invasive, a mastectomy may be necessary. This kind of surgery removes as much of the breast tissue as possible. There are two types of mastectomy: modified radical mastectomy and total, or Halstead, mastectomy.

  • The modified radical mastectomy removes all of the breast tissue on one or both sides depending on whether you have a unilateral or bilateral 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 in which this is 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) will also be 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 skin in 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, so that it can be closed over the reconstructed breast. If your nipple was removed with the mastectomy, you also have the option to have a nipple and areola constructed from your remaining skin.

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 a surgeon. 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 a great help. If they also have good listening skills and are able to answer your questions with clear language and plenty of patience, then you have found a gem.

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 covered. 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. Your surgeon, the hospital, and the anesthesiologist will all bill you and/or your health insurance separately. Doing your homework first can help to prevent any financial surprises after your surgery.

A Word From Verywell

In considering the choice of procedures you would like, it is important that you choose the one which you alone 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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