All About Types of Breast Cancer Surgery

What to know about the different types of breast cancer surgery and why they’re performed

A treatment plan for breast cancer usually includes several different approaches, ranging from chemotherapy and radiation to targeted treatments and immunotherapy. But for almost all women diagnosed with non-metastatic breast cancer, surgery is a major component of treatment.

Learning you need surgery can be stressful, of course, but it may also be confusing because there are several types of breast cancer surgery to consider. What are they, and how will you and your doctor decide what’s best for your situation?

Read on for the answers to these questions and what to expect from each procedure.

What is breast cancer surgery and why is it done?

Breast cancer surgery is most often performed to treat breast cancer. During surgery, your doctor removes the tumor (lumpectomy), or one or both breasts (single or double mastectomy), and possibly lymph nodes to treat your cancer and prevent it from recurring. In some cases, surgery may be the only treatment you need. But often it’s just one part of a larger treatment plan that can also include chemotherapy, radiation, targeted therapy, hormone therapy, and others.

Surgery is also sometimes necessary to diagnose breast cancer. And for those who have a lumpectomy or mastectomy, a surgeon can perform reconstructive surgery if you want to rebuild your breasts.

Breast cancer surgery can be part of treatment for all stages of the disease except for stage 4 (metastatic) breast cancer, which is often better managed with systemic treatments that affect the whole body such as chemotherapy or radiation.

Types of breast cancer surgery

What type of surgery for breast cancer will you need? To answer that question, your doctor looks at several factors, including your overall health, the type of breast cancer you have, how far it has spread, and personal preferences. Options include:

Lumpectomy

A lumpectomy, also referred to as a partial mastectomy or breast-conserving surgery, allows you to keep most of your breast. During the procedure, the surgeon removes the cancer as well as a small border (margin) of healthy tissue surrounding it to ensure all the cancer is removed.

Thanks to advances in screening, early diagnosis, and surgical technique, more women can now choose to undergo lumpectomy with radiation instead of mastectomy than in the past. Still, being diagnosed with breast cancer can be frightening, and many women assume it’s safer to remove their entire breast(s). But if your cancer is in the early stages and you have an average risk of recurrence, research has shown that choosing a mastectomy doesn’t offer any advantages in terms of recurrence risk or long-term survival benefits.

Mastectomy

If you and your doctor decide that one or both breasts should be removed, you’ll need to discuss what type of mastectomy is best for you based on your medical needs and personal preferences. During a simple mastectomy—the most common type—the surgeon removes all breast tissue, skin, and the nipple(s) and leaves the pectoral (chest) muscles beneath. Additional options include:

Skin-sparing mastectomy or nipple-sparing mastectomy. Breast tissue is removed but the skin and/or nipple remain so they can be used in reconstructive surgery.

Mastectomy with breast reconstruction. Depending on your health and treatment plan, your surgeon may be able to perform your mastectomy and breast reconstruction at the same time.

Modified radical mastectomy. Your surgeon removes all breast tissue and the lymph nodes under your arm, which is one area in the body where breast cancer typically spreads.

Radical mastectomy. All breast tissue, underarm lymph nodes, and your pectoral muscles are removed. Radical mastectomy is an old type of breast cancer surgery that’s rarely performed now, but your doctor may recommend it if your cancer has spread to your muscles.

Prophylactic (preventive) mastectomy. Usually, a mastectomy is performed to treat breast cancer and prevent it from coming back, but women with a high risk of breast cancer may choose to remove their breasts to lower the chance that they’ll develop the disease.

While more women have the option of choosing lumpectomy today, there are certain instances when a mastectomy may be more advisable. You may need a mastectomy if you:

• Have inflammatory breast cancer.
• Have a large area of cancer in your breast relative to the volume of your breast, or if you have multiple areas of cancer in your breast. (A lumpectomy is more likely to be recommended if you have a tumor smaller than 2 inches that is also small in comparison to your breast size.)
• Are unable to undergo radiation, which most women need following a lumpectomy.
• Have a genetic mutation (such as in the BRCA1, BRCA2, PALB2 genes.) that may raise your risk of developing a second breast cancer.

Lymph node removal

When you’re diagnosed with breast cancer, your doctor must determine if it has spread (part of the breast cancer staging process). One place where breast cancer can spread is to your lymph nodes. Surgical lymph node removal helps identify the stage of your cancer, which is an essential part of developing a treatment plan that’s most likely to be effective.

There are two types of lymph node surgery:

• Sentinel lymph node biopsy (SLNB) to remove the sentinel node(s), the main draining lymph node(s) from the breast
• Axillary lymph node dissection (ALND) to remove a larger number of lymph nodes

Removal typically takes place during a lumpectomy or mastectomy. If a SLNB reveals the presence of cancer, the surgeon may then perform an ALND while you’re still on the operating table if the pathologist can evaluate the nodes at the time of your surgery. But if the nodes can’t be analyzed for another few days, you may need a ALND later to check additional nodes for cancer.

Breast reconstruction

Many women who undergo mastectomy can choose to have their breast(s) reconstructed. During reconstructive surgery, the surgeon rebuilds the breast(s) with saline or silicone breast implants or with a piece of tissue taken from somewhere else in your body (autologous tissue). It’s also possible to use both. For example, tissue taken from the thigh or buttocks can be used along with an implant to add volume to the breast(s).

Breast reconstruction can be performed during or after your mastectomy. If you choose implants, your surgeon may place the implant above or under your chest muscle. In some cases, he or she might need to place a tissue expander under the chest muscle or the skin that remains after the mastectomy before you get reconstructive surgery. The expander is gradually filled with saline or air over multiple office visits to relax the chest tissue. Once the tissue is healed—typically within two to six months—the surgeon removes the expander and inserts the implant. During autologous tissue reconstruction, also referred to as tissue flap procedure, the surgeon removes a piece of tissue (flap) that contains skin, fat, blood vessels, and sometimes muscle to rebuild the breast(s). Flaps can come from several parts of the body but are most often taken from the abdomen (DIEP flap) or back.

Reconstructive surgery can also be performed if you’re getting a lumpectomy, which is called oncoplastic reconstruction. Depending on how much tissue is removed, a lumpectomy may affect the contour of the beasts and cause asymmetry. The surgeon can reconstruct the breast with an implant, autologous tissue, or fat grafting, or he or she may be able to simply rearrange the remaining breast tissue during the lumpectomy.

What to expect from breast cancer surgery

What is it like to undergo breast cancer surgery? The experience varies depending on the type of surgery you have. Once you and your doctor have decided which one is best for your personal situation, he or she will outline what you can expect from the procedure. While some components of breast cancer surgery are the same regardless of type you get—for example, you’ll always receive general anesthesia—others vary significantly, such as the length of the procedure and the amount of time you’ll need to recover.

A lumpectomy and lymph node removal surgery are less invasive, relatively quick procedures. It takes anywhere from 15 to 40 minutes to perform lumpectomy surgery, though it will last longer if you’re getting a SNLB or ALND at the same time. Both a lumpectomy and lymph node removal surgery are outpatient procedures, so you don’t have to stay overnight in the hospital. Any pain or tenderness following these surgeries is usually mild enough to be treated with over the counter (OTC) pain medication. It takes about two weeks to recover, though you can likely  return to some of your everyday activities a few days after surgery as long as they don’t involve heavy lifting.

Mastectomy and reconstructive breast surgery, on the other hand, are more extensive procedures. It takes about one to two hours to perform a mastectomy, and you may need to spend a night or two at the hospital following a mastectomy, though some women are able to go home the same day as the surgery. An OTC pain reliever may be all you need to manage the pain, though in some cases your doctor will prescribe stronger pain medication. Recovery takes about three or four weeks.

If you have reconstructive surgery at the same time as your mastectomy, the procedure takes two to three hours if you’re getting an implant or six to 12 hours if your surgeon is using your own to tissue to rebuild the breast. You may need to stay at the hospital for a week, and the recovery time is longer (six to eight weeks). In most instances, your doctor will provide you with prescription painkillers to manage discomfort following surgery.

Thanks to advances in surgical and reconstruction procedures, patients have several options. Learning more about them can help alleviate some of the stress of a breast cancer diagnosis. Your breast cancer care team can provide further guidance as you navigate the best approach.