Types of surgery for breast cancer
This page describes the different types of surgery for breast cancer. You may be given a choice of treatment, depending on the size and position of the cancer. Your doctor will discuss your options with you. We also have information on the benefits and disadvantages of each type of surgery.
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Wide local excision (lumpectomy)
This is when the cancer and an area of surrounding tissue is removed. It’s called a wide local excision or lumpectomy. This operation removes the affected breast tissue and for most women the appearance of their breast after a lumpectomy is good.
If the lump is very small, a fine wire (guide wire) is used to mark the area to be removed so that the surgeon can find it more easily. The doctor or radiologist will inject some local anaesthetic into the area to numb it before inserting the wire, using x-ray or ultrasound to guide them.
Occasionally, an operation called a quadrantectomy is done. This removes a larger area of breast tissue. The effect on the appearance of the breast will be more noticeable than after a lumpectomy. The treated breast will be smaller than your other breast and there may be a noticeable dent in it. Women can have surgery to reduce the size of the other breast (mammoplasty) so that both breasts are the same size.
After these operations you’ll need to have radiotherapy to the remaining breast tissue to destroy any cancer cells that may have been left behind.
After a lumpectomy, the pathologist examines the tissue that’s been removed to see if there is an area or margin of normal cells around the cancer. This is called a clear margin. If the margins are clear, you won’t need any more surgery to the breast. If there is still cancerous or precancerous (DCIS) cells at the edge of the breast tissue, you’ll need another operation to remove more tissue. This reduces the chance of the cancer coming back in the future.
If taking away more tissue is unlikely to remove all the cancer cells, a mastectomy is usually advised.
Some women may need to have all of the breast removed (mastectomy). A mastectomy is usually advised if:
the lump is large in proportion to the rest of the breast
there are areas of cancer in different parts of the breast (multi-focal)
there’s widespread DCIS in the breast
you’ve previously had radiotherapy to the chest, for example, to treat Hodgkin lymphoma.
Types of mastectomy
A mastectomy removes all of the breast tissue. At the same time, you may have a test to check the lymph nodes in your armpit, or have some (or all) of the nodes removed.
A radical mastectomy is where all the breast tissue, the muscles behind the breast and the lymph nodes in the armpit are removed. It’s only done if the cancer is found in the muscle under the breast. But this type of mastectomy is rarely needed as chemotherapy or hormonal therapy can usually be given before surgery to shrink the cancer. This means a mastectomy that removes only the breast tissue can then be done.
If you’re having a mastectomy, you’ll usually be offered breast reconstruction at the same time. This is when a new breast shape is formed. Breast reconstruction is very specialised surgery. Surgeons who do this type of operation may be plastic surgeons or oncoplastic surgeons, who are trained in both breast cancer surgery and reconstruction surgery.
Different techniques are used – for example, muscle from the back or the tummy area, or a silicone implant can be used. Some women may decide not to have it done immediately – it can be done months or even years after a mastectomy.