Surgery for Breast Cancer
Surgery is a common treatment for breast cancer, and its main purpose is to remove as much of the cancer as possible. There are different types of surgery. You may have a choice about which type to have. Or your doctor may recommend a certain operation based on your breast cancer type and your medical history. It’s important to know about your options so you can talk about them with your doctor and make the choice that is right for you.
Most women with breast cancer have some type of surgery as part of their treatment. Depending on the situation, surgery may be done for different reasons. For example, surgery may be done to:
- Remove as much of the cancer as possible (breast-conserving surgery or mastectomy)
- Find out whether the cancer has spread to the lymph nodes under the arm (sentinel lymph node biopsy or axillary lymph node dissection)
- Restore the breast’s shape after the cancer is removed (breast reconstruction)
- Relieve symptoms of advanced cancer
Surgery to remove breast cancer
There are two main types of surgery to remove breast cancer:
- Breast-conserving surgery (also called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy) – in which only the part of the breast containing the cancer is removed. The goal is to remove the cancer as well as some surrounding normal tissue. How much of the breast is removed depends on the size and location of the tumor and other factors.
- Mastectomy – in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomies. Some women may also get a double mastectomy, in which both breasts are removed.
Choosing between breast-conserving surgery and mastectomy
Many women with early-stage cancers can choose between breast-conserving surgery (BCS) and mastectomy. The main advantage of BCS is that a woman keeps most of her breast. But in most cases she will also need radiation. Women who have mastectomy for early stage cancers are less likely to need radiation.
For some women, mastectomy may clearly be a better option, because of the type of breast cancer, the large size of the tumor, previous treatment history, or certain other factors.
Surgery to remove nearby lymph nodes
To find out if the breast cancer has spread to axillary (underarm) lymph nodes, one or more of these lymph nodes will be removed and looked at under the microscope. This is an important part of figuring out the stage (extent) of the cancer. Lymph nodes can be removed either as part of the surgery to remove the breast cancer or as a separate operation.
The two main types of surgery to remove lymph nodes are:
- Sentinel lymph node biopsy (SLNB) – in which the surgeon removes only the lymph node(s) under the arm to which the cancer would likely spread first. Removing only one or a few lymph nodes lowers the risk of side effects from the surgery.
- Axillary lymph node dissection (ALND) – in which the surgeon removes anywhere from about 10 to 40 (though usually less than 20) lymph nodes from under the arm. 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 situations.
To learn more about these procedures and when they might be done, see Lymph node surgery for breast cancer.
Breast reconstruction after surgery
After having a mastectomy (or some breast-conserving surgeries), a woman might want to consider having the breast mound rebuilt to restore the breast’s appearance after surgery. This is called breast reconstruction.
There are several types of reconstructive surgery, although your options may depend on your medical situation and personal preferences. You may have a choice between having breast reconstruction at the same time as the mastectomy (immediate reconstruction) or at a later time (delayed 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. This gives the surgical team time to plan out the treatment options that might be best for you, even if you wait and have the reconstructive surgery later.
To learn about different breast reconstruction options, see our section on breast reconstruction.
Surgery for advanced breast cancer
Although surgery is very unlikely to cure breast cancer that has spread to other parts of the body, it can still be helpful in some situations, either as a way to slow the spread of the cancer, or to help prevent or relieve symptoms from it. For example, surgery might be used:
- When the breast tumor is causing an open wound in the breast (or chest)
- To treat a small number of areas of cancer spread (metastases) in a certain part of the body, such as the brain
- When an area of cancer spread is pressing on the spinal cord
- To treat a blockage in the liver
- To provide relief of pain or other symptoms
If your doctor recommends surgery for advanced breast cancer, it’s important that you understand its goal—whether it’s to try to cure the cancer or to prevent or treat symptoms.
Morrow M, Burstein HJ, Harris JR. Chapter 79: Malignant Tumors of the Breast. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Breast Cancer. Version 2.2016. Accessed at www.nccn.org on June 1, 2016.
Wolff AC, Domchek SM, Davidson NE, Sacchini V, McCormick B. Chapter 91: Cancer of the Breast. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.
Last Medical Review: June 1, 2016 Last Revised: August 18, 2016