The goal of breast cancer surgery is to remove the tumor and a portion of surrounding tissue while conserving as much of the breast as possible.
Breast cancer surgery methods differ in the amount of breast tissue that is taken out with the tumor. That depends on the tumor location, how far it's spread, and your personal feelings. The surgeon also removes some lymph nodes under the arm so they can be tested for cancer cells. This will help your doctor plan your treatment after surgery.
Before you have surgery for breast cancer, take some time to learn about the different types of procedures. You and your doctor will choose the best option for you.
Simple or Total Mastectomy
Your doctor removes your entire breast, including the nipple, in this procedure. They may remove one to three lymph nodes -- small glands that are part of your immune system -- from your underarm. You’re most likely to have this procedure when you are not at high risk of having cancer in your lymph nodes or if you’re having a mastectomy to lower your risk of getting breast cancer.
Modified Radical Mastectomy
The surgeon removes all of your breast tissue, including your nipple and most of the lymph nodes in the armpit. They leave the chest muscles intact.
This may be a good option if you have invasive breast cancer.
Your surgeon removes all of your breast tissue along with the nipple, lymph nodes in your armpit, and chest wall muscles under the breast.
This procedure is rarely done today. The modified radical mastectomy is as effective in most cases, and it's less disfiguring. A radical mastectomy is usually recommended only if the cancer has spread to your chest muscles.
Your surgeon removes the skin of the nipple and areola, and the area where the tumor was taken out, but leaves the rest of the skin so it can be used for your breast reconstruction.
It may not be an option for you if you have cancer cells close to your skin or if you plan to wait to have breast reconstruction.
Your surgeon removes breast tissue and typically some lymph nodes, but leaves the nipple, areola, and skin of the breast that can be used for your breast reconstruction.
It may not be an option if you have cancer cells close to the nipple or areola.
Lumpectomy (Partial Mastectomy)
Your surgeon removes the tumor along with some of the breast tissue surrounding it. You may need radiation treatments afterward.
This may not be a good option for you if radiation therapy is recommended after surgery and you can’t or won’t have radiation.
Also, a lumpectomy is usually not an option if you have a large tumor or if cancer has grown outside the breast tissue.
Lymph Node Surgery
An important part of breast cancer surgery involves checking the lymph nodes to see if the cancer has spread. The doctor usually does this at the time of the original surgery, but they can also do it later. There are two main types of lymph node surgery for breast cancer:
- Axillary lymph node dissection (ALND). The surgeon takes out about 10 to 20 lymph nodes from under the arm. Those get checked for cancer.
- Sentinel lymph node biopsy. The surgeon finds and removes the lymph node where the breast cancer would most likely have spread first. This surgery is less likely to cause lymphedema, or swelling in the arm, than an ALND.
Many women who get a mastectomy choose to get breast reconstruction either right afterward or later on. You can use breast implants or your own tissue, usually from your lower belly.
Preparing for Breast Cancer Surgery
No matter what type of breast cancer surgery you have, you’ll need to take steps to get ready.
One of the first things you’ll need to do is to give your medical history. Your doctor will ask you about any medications you’re taking, including vitamins and supplements. They’ll also want to know if you’ve had any reactions to medications or surgical procedures in the past. If you have any conditions that could affect how your body responds to surgery, such as heart disease, diabetes, or high blood pressure, you should let your doctor know at this time.
Your doctor may suggest that you donate a pint or two of blood in case you need it during surgery. If you do this, you’ll need to allow extra time in your pre-op schedule to donate and recover.
As your surgery date gets closer, your doctor may order tests for you. These can include a chest X-ray, EKG, and blood and urine tests. These tests let your doctor know if your body is ready for the operation. They may also request a CT scan or breast MRI to check the size and location of your tumor.
How Long Will I Be in the Hospital?
The length of your stay in the hospital will vary depending on the type of surgery you have, how well you tolerate the operation, and your general health.
Lumpectomies are usually outpatient procedures. You’ll recover in a short-stay observation unit and will likely go home later the same day.
If you have a mastectomy or an ALND, you’ll probably stay in the hospital for 1 or 2 nights.