Most women with breast cancer have some type of surgery

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

In these types of surgery, only a part of the breast is removed. How much is removed depends on the size and place of the tumor and other factors. It is sometimes called partial (or segmental) mastectomy.

Lumpectomy: This surgery removes only the breast lump and some normal tissue around it. Radiation treatment is usually given after this type of surgery. If chemotherapy is also going to be used, the radiation may be put off until the chemo is finished. If there is cancer at the edge (called the margin) of the piece of tissue that was removed, the surgeon may need to go back and take out more tissue.

Partial (segmental) mastectomy or quadrantectomy: This surgery removes more of the breast tissue than in a lumpectomy. It is usually followed by radiation therapy. But radiation may be delayed if chemotherapy is also going to be given. Side effects of these operations can include pain, short-term swelling, tenderness, and hardness due to scar tissue that forms in the surgical site.

If cancer cells are found at any of the edges of the piece of tissue removed, it is said to have positive margins. When no cancer cells are found at the edges of the tissue, it is said to have negative or clear margins. The presence of positive margins means that that some cancer cells may have been left behind after surgery. If the lab finds positive margins in the tissue removed with surgery, the surgeon may need to go back and remove more tissue. This operation is called a re-excision. If the surgeon can't remove enough breast tissue to get clear margins, a mastectomy may be needed.

The more of breast removed, the more likely it is that 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 reconstructive surgery (see the section, "Reconstructive or breast implant surgery"), or have the other breast made smaller to make the breasts look more alike. This might even be done during the first surgery. So 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.

For most women with stage I or II breast cancer, breast-conservation therapy (lumpectomy/partial mastectomy plus radiation therapy) works as well as mastectomy. Survival rates of women treated with these two approaches are the same.

Mastectomy

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

Simple (also called total) mastectomy: In this surgery the entire breast is removed, but not the lymph nodes under the arm or the muscle tissue beneath the breast. Sometimes both breasts are removed, especially when mastectomy is done to try to prevent cancer. If a hospital stay is needed, most women can go home the next day.

For some women who are planning on having reconstruction right away, a skin-sparing mastectomy can be done. For this, most of the skin over the breast (other than the nipple and areola) is left intact. This can work as well as a simple mastectomy. The amount of breast tissue removed is the same as with a simple mastectomy. Although this approach has not been used for as long as the more standard type of mastectomy, many women prefer it because there is less scar tissue and the reconstructed breast seems more natural.

Another option for some women is the nipple-sparing mastectomy. This procedure is more often an option for women who have a small early stage cancer near the outer part of the breast, with no signs of cancer in the skin or near the nipple.

Modified radical mastectomy: This operation involves removing the entire breast and some of the lymph nodes under the arm. This was once the most common surgery for women with breast cancer who were having the whole breast removed, but it is less often done now.

Radical mastectomy: This is a major operation where the surgeon removes the entire breast, underarm (axillary) lymph nodes, and the chest wall muscles under the breast. This surgery was once very common, but it is rarely done now because modified radical mastectomy has proven to work just as well. But this operation may still be done for large tumors that are growing into the muscles under the breast.

Possible side effects

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).

This information was provided by the American Cancer Society.