Types of surgery for breast cancer in men

If you have surgery to remove breast cancer, it usually means removing all of the breast tissue and the nipple in the affected breast. This is called a mastectomy. Some men may have a wide local excision (WLE, or lumpectomy) instead. This means just removing the cancer and some surrounding normal tissue.

During the operation, your surgeon may remove some of the lymph nodes in your armpit to check them for cancer cells. If the nodes contain cancer cells, you will have another operation to remove all the lymph nodes. There are different types of lymph node surgery.

A sentinel lymph node biopsy (SLNB) removes the sentinel lymph nodes. These are the first lymph nodes that lymph fluid drains to. Sentinel lymph nodes are most likely to be affected by any cancer that has spread from the breast tissue. An axillary lymph node dissection (ALND) takes away all the lymph nodes in the armpit.

Surgery to the lymph nodes may increase your risk of developing swelling of the arm called lymphoedema.

Surgery

Most men only have a small amount of breast tissue, so the most common operation involves taking away all of the breast tissue and the nipple. This is called a mastectomy. You will usually have some or all of the lymph nodes removed from the armpit during this operation.

Occasionally the surgeon may be able to remove only the area of the cancer with some surrounding normal-looking tissue. This operation is called a wide local excision and for some men it may mean that they keep their nipple. It may also be referred to as a lumpectomy.

After this operation, the pathologist examines the tissue that’s been removed to see if there is an area of normal cells around the cancer. This is called a clear margin. If there are still cancer cells at the edge of the removed breast tissue, you’ll need to have a mastectomy.

Before your operation, your surgeon will talk to you about the type of operation that is recommended for you.

Your surgeon or breast care nurse will talk to you about how your chest will look after your surgery. They may show you photographs of other men who have had breast surgery or put you in touch with someone who has been through it. Or you can contact a support group or Breast Cancer Care.

I have a scar across my chest but I don’t worry about it. My chest hair has grown over it so I’m not very self-conscious.

Herbie


Surgery to the lymph nodes

Your surgeon may remove some or all of the lymph nodes in your armpit. There are different types of lymph node surgery.

Sentinel lymph node biopsy (SLNB)

This may be done if you have a small cancer and the ultrasound of your armpit is normal. SLNB isn’t suitable for everyone – your surgeon will explain if it’s an option for you.

A sentinel lymph node biopsy is a way of checking the smallest possible number of lymph nodes (usually 1–3) in the armpit to see if they contain cancer cells. The sentinel nodes are the first ones that lymph fluid drains to from the breast, so they are the most likely to contain any cancer cells. If the sentinel nodes don’t contain cancer cells, you won’t need surgery to remove more lymph nodes.

Removing only the sentinel lymph nodes lessens the risk of side effects that can sometimes occur after lymph node surgery. These include swelling of the arm known as lymphoedema and stiffness of the arm.

How an SLNB is done

The doctor or a technician will inject a tiny amount of radioactive liquid, which is harmless, into your breast, usually around the nipple. You have this done on the day of surgery or sometimes the day before.

During the operation, the surgeon may inject a blue dye into your breast, which stains the lymph nodes blue. The sentinel lymph nodes absorb the radioactivity or become blue first.

The surgeon uses a small handheld instrument to find the lymph nodes that have picked up the radioactivity. They only remove the blue or radioactive nodes (sentinel nodes). These are tested to see if they contain cancer cells.

If any of the nodes contain cancer cells, you may have further surgery to remove all the lymph nodes (axillary lymph node dissection). Some men may have radiotherapy to the lymph nodes instead of surgery.

Removing all the lymph nodes

In some cases, the surgeon will want to remove all the lymph nodes in the armpit. This is called an axillary lymph node dissection (ALND) or clearance. It removes any nodes that contain cancer cells. You usually won’t need radiotherapy to the area afterwards.

An ALND is usually done when:

  • the ultrasound of the lymph nodes is abnormal, and
  • a biopsy of the lymph nodes is positive, or
  • the sentinel node biopsy shows there are cancer cells in the nodes.

There’s an increased risk of developing swelling of the arm called lymphoedema after an ALND.

Back to Surgery explained

Who might I meet?

A team of specialists will plan your surgery. This will include a surgeon who specialises in your type of cancer.

Recovering from surgery

Your nurse and physiotherapist will give you advice and support for recovery after your operation.