Surgery and Other Procedures for Breast Cancer

Surgery to remove breast cancer

Two main types of surgery are used to remove breast cancer.

• Breast-conserving surgery removes the cancer and some surrounding normal tissue. The remainder of the breast stays in place. The amount of tissue removed will depend on the size of the tumor, its location, and other factors. This surgery is also called a lumpectomy or partial mastectomy.
• Mastectomy removes the entire breast. This includes all of the breast tissue and sometimes other nearby tissues. There are several types of mastectomy. Some people have both breasts removed in a double mastectomy.

Cryoablation therapy to remove breast cancer

Cryoablation therapy is a treatment that freezes and destroys cancer cells without surgery. It may be an alternative to surgery for some women who are 70 years or older with early-stage, low-risk breast cancer.

Low-risk breast cancers are usually:

• Found in one area of the breast
• 1.5 cm or smaller
• Hormone receptor-positive (estrogen and progesterone)
• HER2-negative
• Growing slowly (based on special lab tests)
• Not spread to the lymph nodes

Cryoablation is done under local anesthesia. You stay awake, but the area is numb. During the procedure, the doctor uses ultrasound to guide a thin needle into the tumor. The tip of the needle releases extreme cold that freezes and destroys the cancer cells. This usually takes less than an hour.

Most people recover quickly and can return to normal activities the same day. Side effects include temporary bruising or swelling.

Surgery to remove nearby lymph nodes

Your cancer care team needs to find out if breast cancer has spread to the lymph nodes under your arm (axillary lymph nodes). To do this, they will remove one or more of these lymph nodes and look at them in the lab. This helps them figure out the stage of your cancer, meaning how big it is and where it has spread.

These lymph nodes may be taken out as part of the surgery to remove your breast cancer, or they may be taken out in a separate surgery.

There are 2 main types of surgery to remove lymph nodes.

• Sentinel lymph node biopsy (SLNB): For SLNB, the surgeon injects a dye and then removes only the underarm lymph node(s) that take up the dye. These lymph nodes are where the cancer would likely spread first. Removing no more than a few lymph nodes lowers the risk of lymphedema (arm swelling) and other side effects.
• Axillary lymph node dissection (ALND): For ALND, dye is not used to find the lymph nodes where cancer would likely spread first. Instead, the surgeon removes many underarm lymph nodes. Usually, less than 20 nodes are removed. ALND is not done as often as it was in the past, but it might still be the best way to look at the lymph nodes in some cases.

In certain situations, some people with early-stage breast cancer may not need lymph node surgery at all. You and your cancer care team will decide together on the best plan for you.

Localization to guide surgery

Sometimes a breast tumor is hard to find or hard to reach. In these cases, the radiologist places a small marker in your breast before surgery. They use a mammogram, ultrasound, or sometimes MRI to guide them. During surgery, the surgeon uses this marker to find the exact area that needs to be removed.

Several types of markers can be used for this.

• Wire markers: A thin wire is placed with its tip at the tumor site. The other end sticks out through your skin. This must be done on the same day as surgery, shortly before your operation.
• Reflector or GPS-type markers: This method uses a small device such as a radar reflector, magnetic seed, or radioactive seed to mark the tumor area. These devices can be placed days or even weeks before surgery. Nothing sticks out through your skin. During the operation, the surgeon uses a probe to detect the marker's signal and find the right area, similar to how a GPS finds a location.

The type of marker used will depend on what is available at your hospital and what your radiologist and surgeon recommend.

Breast reconstruction after surgery

Many people have the option of breast reconstruction after surgery to remove breast cancer.

Several types of reconstructive surgery are available. Your options will depend on your medical situation and personal preferences. You may have a choice between immediate reconstruction at the same time as the breast cancer surgery or delayed reconstruction later.

• After mastectomy you can often have your breast mound rebuilt to restore the way it looks. This might be done using an implant or your own tissues.
• After some breast-conserving surgeries you may decide to have fat grafted. This involves moving fat from another part of your body into the affected breast. It can help correct any dimples left from the surgery.

Planning ahead for reconstruction

If you are thinking about having reconstructive surgery, it’s a good idea to discuss it with your breast surgeon and a plastic surgeon before your mastectomy or breast-conserving surgery. This gives the surgical team time to plan out your options, even if you wait until later to have reconstruction.

Surgery and/or radiation for advanced breast cancer

Surgery is very unlikely to cure breast cancer that has spread to other parts of your body. But in some situations, it might help prevent or relieve your symptoms. It can still be a very important part of your care.

In this case, the goal of surgery is to help you feel better, manage symptoms, and improve your quality of life.

For example, surgery might be used when:

• An area of cancer is pressing on your spinal cord.
• Cancer has weakened a bone or put it at risk of breaking. Surgery can help stabilize the bone and radiation can help ease pain. 

Surgery might also be used to:

• Treat a small number of areas of cancer metastases in a certain part of your body, such as your brain.
• Treat a blockage in your liver.
• Relieve pain or other symptoms.

If your cancer care team recommends surgery for advanced breast cancer, it’s important that you understand the goal of the surgery. Ask if the goal is to try to cure the cancer or to prevent or treat symptoms.

Exercises to help with arm and shoulder movement after surgery

After breast surgery, it’s important to do exercises to get your arm and shoulder moving again. These exercises help decrease the side effects of your surgery and get you back to your usual activities.