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Types of Breast Cancer Surgery
Surgery is almost always needed to treat breast cancer. Depending on its type and stage, one of several surgical procedures below may be considered.
Simple Mastectomy
A simple or total mastectomy involves the removal of the entire breast, and rarely the underlying muscle. It is commonly performed in cases of widespread cancer or when there is a high risk of recurrence. A mastectomy is often pursued over less-invasive surgeries when the tumor is large, there are multiple tumors, or due to genetic factors that significantly increase the risk of cancer.
Modified Radical Mastectomy
A modified radical mastectomy removes the entire breast along with the axillary lymph nodes (or armpit lymph nodes) under the arm, while leaving the chest wall muscles in place. It’s typically considered when cancer has spread to nearby lymph nodes and is more extensive than a simple mastectomy.
Double Mastectomy
A double or bilateral mastectomy removes both breasts, even when cancer is present only in one. This is most often considered by patients with a BRCA1 or BRCA2 gene mutation, either as a risk-reducing measure or alongside treatment for a confirmed diagnosis.
Nipple-Sparing Mastectomy
This is a variation of the traditional mastectomy where all breast tissue is removed, while the nipple, areola and surrounding skin are preserved. It is often an option for early-stage cancers. The benefit of this approach is that it can offer better cosmetic results and may help with the psychological challenges of breast cancer recovery.
Skin-Sparing Mastectomy
Similar to nipple-sparing mastectomy, this procedure involves the removal of all breast tissue, the nipple and the areola, but preserves most of the breast skin. This is typically used for early-stage breast cancer and is often followed by immediate breast reconstruction. The advantage is that it allows for more natural-looking reconstruction results.
Lumpectomy (Partial Mastectomy)
Also known as breast-conserving surgery, a lumpectomy involves removing only the tumor and a small margin of surrounding healthy tissue. It is commonly used for early-stage breast cancers and is often followed by radiation therapy. This surgery is chosen when the cancer is small and localized, allowing for breast preservation.
Hidden Scar Breast Cancer Surgery
This is a technique used in both lumpectomy and mastectomy where incisions are made in less visible areas — such as under the breast, along the edge of the areola or in the armpit — to minimize scarring. It's suitable for a variety of cancer stages and types. The choice of this surgery is often driven by the desire to improve cosmetic outcomes and lessen the emotional impact of surgical scars.
Lymphadenectomy (Lymph Node Removal)
To determine if cancer has spread beyond the breast, lymph nodes around the affected area of the breast, typically in the armpit area, may be removed. This enables lymph node tissue to be examined under a microscope for the presence of cancer cells, making it an important part of breast cancer staging.
How Does Breast Cancer Surgery Work?
Breast cancer surgery is performed under general anesthesia. For a lumpectomy, the surgeon removes the tumor and a margin of healthy tissue, sometimes guided by wire localization or radiofrequency localization to precisely mark the tumor’s location.
For a mastectomy, the surgeon removes some or all of the breast tissue, depending on the type of mastectomy planned. If lymph nodes are being checked, the surgeon may perform a sentinel lymph node biopsy, sending the tissue to a pathologist during or after surgery to determine whether an axillary lymph node (under your arm) dissection is needed.
When reconstruction is planned for the same operation, the reconstructive surgeon proceeds immediately after the breast surgeon completes cancer removal. One aspect of this comprehensive plan includes a sophisticated surgical technique, in which our highly trained reconstructive surgeons restore breast sensation after surgery.
Breast Cancer Surgery Success Rates
Breast cancer surgery has strong outcomes for most patients, particularly when cancer is caught at an early stage. Outcomes vary based on cancer subtype and stage, whether the lymph nodes are involved and individual patient factors. Five-year survival rates for localized cases approach 99%. Our team reviews each case individually before recommending a surgical approach with the best possible outcomes.
What Conditions Does Breast Cancer Surgery Treat?
There are numerous breast cancer subtypes. While not all are treated by surgery, many are. These subtypes include:
Ductal Carcinoma in Situ
Ductal carcinoma in situ (DCIS) is a non-invasive, early-stage condition in which abnormal cells are confined to the milk ducts. Surgery, usually a lumpectomy, is often the primary treatment, sometimes followed by radiation therapy.
Invasive Breast Cancer
Invasive breast cancer has spread beyond the milk ducts or lobules into surrounding breast tissue. Surgery is a core part of treatment for early-stage breast cancer, often combined with lymph node evaluation and chemotherapy, radiation therapy or hormone therapy.
Inflammatory Breast Cancer
Inflammatory breast cancer (IBC) is a rare, fast-growing type that typically requires chemotherapy before surgery, followed by a mastectomy and radiation therapy.
Metastatic Breast Cancer
In metastatic breast cancer (MBC), where the disease has spread beyond the breast, surgery plays a more limited role and is generally considered on a case-by-case basis alongside systemic treatments like chemotherapy, hormone therapy or targeted therapy.
Who Qualifies for Breast Cancer Surgery?
Most people with a qualifying breast cancer diagnosis will be eligible for breast cancer surgery. Beyond general candidacy for surgery, patients with a BRCA1 or BRCA2 mutation, identified through genetic testing, may also be candidates for a risk-reducing double mastectomy, even without a current diagnosis. Your care team will review your mammogram results, biopsy findings and genetic testing results together before recommending a specific surgical approach.
Preparing for Breast Cancer Surgery
Your care team will walk you through what to expect prior to your surgery. In general, preparation may include:
- Completing a diagnostic mammogram or other imaging
- Discussing whether wire localization or radiofrequency localization will be used to mark the tumor before surgery
- Reviewing whether any chemotherapy, hormone therapy or targeted therapy is planned before surgery to shrink the tumor
- Stopping blood-thinning medications as directed by your surgical team
- Quitting smoking well in advance
- Arranging for help at home in the initial days of your recovery
Recovering from Breast Cancer Surgery
Recovery depends on the type of surgery performed.
A lumpectomy typically allows patients to go home the same day, while a mastectomy, especially one that includes lymph node removal, may require a short hospital stay.
Common side effects of breast cancer surgery include swelling, discomfort and a temporary drain at the surgical site. Removing lymph nodes carries an increased risk of lymphedema, a buildup of fluid in the arm due to disruption of the lymphatic system. There may also be a risk of seroma, a fluid collection near the surgical site.
Once your pathologist has reviewed the removed tissue, your care team will discuss whether chemotherapy, radiation therapy or hormone therapy is a recommended next step.