Breast Cancer Overview

+ -Text Size

Treating Breast Cancer TOPICS

Surgery for breast cancer

Most women with breast cancer have some type of surgery to treat the main breast tumor. The purpose of surgery is to remove as much of the cancer as possible. Surgery can also be done to find out whether the cancer has spread to the lymph nodes under the arm, to restore the breast’s shape after a mastectomy, or to relieve symptoms of advanced cancer. Below is a list of some of the most common types of breast cancer surgery.

Breast-conserving surgery (BCS)

This type of surgery removes only a part of the breast. How much is removed depends on the size and place of the tumor and other factors. The medical term for this surgery is partial (or segmental) mastectomy, but it is often called lumpectomy or quandrantectomy.

The removed tissue will be looked at to see if cancer cells are found at any of the edges or even close to the edges. If they are, it means that some cancer cells may have been left behind. More surgery is often needed. For some women, this can mean a mastectomy.

Sometimes the breast becomes swollen and tender for some time after surgery. This will get better over time.

The more breast tissue removed, the more likely it is there will be a change in the shape of the breast afterward. If the breasts look very different after surgery, you might be able to have some type of surgery (see “Reconstructive or breast implant surgery” below) to improve the way the breast looks. Sometimes surgery is done on the other breast so the breasts look more alike. You should talk with your doctor before surgery to get an idea of how your breasts are likely to look afterward and to learn what your options might be.

BCS usually needs to be followed by radiation treatment. Women who can’t get radiation (or who aren’t willing to get it) often cannot have BCS. Even if a woman can get radiation, there may be other medical reasons that BCS is not an option. These are discussed in detail in our document, Breast Cancer.

Mastectomy

Mastectomy is surgery that removes the entire breast. All of the breast tissue is removed, sometimes along with other nearby tissues.

If just the breast is removed (and not lymph nodes under the arm) it is called a simple (or total) mastectomy. A simple mastectomy combined with an axillary lymph node dissection (discussed below) is called a modified radical mastectomy.

Many women choose to have their breasts reconstructed after these surgeries. It may even be an option to have reconstruction and mastectomy done in the same operation.

Radical mastectomy: In this operation, the surgeon takes a modified radical mastectomy one step further by also removing the muscles of the chest wall under the breast. This is only needed if the cancer is growing into the muscles under the breast.

Possible side effects of breast surgery

Aside from pain after the surgery and the change in the shape of the breast(s), the possible side effects of mastectomy and breast-conserving surgery include wound infection, build-up of blood in the wound, and build-up of clear fluid in the wound. If axillary lymph nodes are also removed, other side effects are possible, such as swelling of the arm and chest (lymphedema).

It is important to know that for women with early breast cancer, having a mastectomy instead of BCS plus radiation only lowers your risk of developing a second breast cancer in the same breast. It does not lower the chance of the cancer coming back in other parts of the body. It is important that you don’t rush into making a decision, but instead take your time deciding whether a mastectomy or BCS plus radiation is right for you.

Lymph node surgery

To find out if the breast cancer has spread to lymph nodes under the arm (axillary lymph nodes), one or more of these lymph nodes may be removed and looked at under the microscope. This is an important part of staging, and the results affect treatment and outcomes. When the lymph nodes contain cancer cells, there is a higher chance that cancer cells have also spread through the bloodstream to other parts of the body. These lymph nodes are checked in 2 major ways.

Axillary lymph node dissection: In this operation, about 10 to 40 (though in most cases less than 20) lymph nodes are removed. Axillary lymph node dissection is usually done at the same time as the mastectomy or breast-conserving surgery, but it can be done in a second operation. This was once the most common way to check for breast cancer spread to nearby lymph nodes, and it is still done in some patients.

Sentinel lymph node biopsy: A sentinel lymph node biopsy is a way to learn if cancer has spread to the lymph nodes under the arm without removing so many of them. For this test, a radioactive substance and/or a blue dye are injected into the breast. This is carried by the lymph system to the nodes that first get lymph from the tumor. These lymph nodes (called the sentinel lymph nodes) are also the one most likely to contain cancer cells if the cancer has spread. The surgeon sees which nodes picked up the blue dye and uses a detector to find the ones containing radiation. These are then removed. If the sentinel nodes contain cancer, more lymph nodes may be removed (either right away or in a separate surgery). If they are free of cancer, further lymph node surgery usually is not needed. This type of biopsy calls for a great deal of skill, so it is best to have it done by a team who has experience with it. This test isn’t done if cancer has already been found in the lymph nodes by needle biopsy.

Side effects: As with other operations, pain, swelling, bleeding, and infection are possible. The main possible long-term effect of lymph node surgery is swelling in the arm or chest (lymphedema). This is less common after a sentinel lymph node biopsy than an axillary dissection. Sometimes the swelling lasts for only a few weeks and then goes away. Other times, the swelling comes up later or lasts a long time. Ways to help prevent or reduce the effects of lymphedema are discussed in the section, “Lymphedema after breast cancer treatment.” If your arm is swollen, tight, or painful after lymph node surgery, be sure to tell someone on your cancer care team right away.

Reconstructive or breast implant surgery

After having a mastectomy (or some breast-conserving surgeries), a woman may want to think about having the breast mound rebuilt. These operations are not meant to treat the cancer. They are done to restore the way the breast looks. If you are having breast surgery and are thinking about having breast reconstruction, you should talk to a plastic surgeon before your operation. There are choices to be made, such as when the surgery can be done and exactly what type it will be.

You can get more detailed information about the different types of surgery and their possible side effects in our document, Breast Reconstruction After Mastectomy. You may also find it helpful to talk with a woman who has had the type of reconstruction you are thinking about. Our Reach To Recovery volunteers can help you with this. Call us if you would like to speak to one of these volunteers.

Chronic pain after breast surgery

After breast surgery, some women have pain that doesn’t go away over time. This is called post-mastectomy pain syndrome (PMPS), but it can happen after breast-conserving surgery, too. It is more common if a full axillary lymph node dissection is done as a part of surgery. The symptoms of PMPS are chest wall pain and tingling down the arm. Pain may also be felt in the shoulder, scar, arm, or armpit. Other common complaints include numbness, shooting or pricking pain, or unbearable itching. These seem to be related to nerve damage.

It is important to tell your doctor about any pain you are having. PMPS can cause you to not use your arm the way you should, and over time you might not be able to use it normally. Talk to your doctor to get the pain control you need.


Last Medical Review: 09/17/2013
Last Revised: 01/31/2014