Types of surgery for breast cancer

Surgery is one of the main treatments for breast cancer. The type of surgery you have depends on the stage of the cancer and your own preferences. Your surgeon usually tries to keep as much of the breast as possible (breast-conserving surgery), although you may need to have the whole breast removed (mastectomy). You may be asked to decide which operation you have.

The chances of surviving early breast cancer are similar with breast-conserving surgery and radiotherapy, or a mastectomy.

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

If you are having a mastectomy, your surgeon will ask if you want a new breast shape to be made at the same time. This is called breast reconstruction. You may chose not to have this or may want to wait until you’ve finished other cancer treatments.

Surgery for breast cancer

Surgery is one of the main treatments for breast cancer. The operation you have depends on the size and position of the cancer and your own preference. Your surgeon and breast care nurse will talk to you about your options. You may be asked to decide which operation you have.

Your surgeon will usually recommend surgery that keeps as much of the breast tissue and the shape of the breast as possible (breast-conserving surgery). But in some situations, they may recommend having all of the breast removed (mastectomy). Some women have hormonal therapy or chemotherapy before their operation to try to shrink the cancer to avoid having a mastectomy.

Your surgery will usually include removing some or all the nodes in your armpit.


Wide local excision (lumpectomy)

The surgeon removes only the cancer and some of the normal looking tissue all around it (the margin). This is called a wide local excision (WLE).

In early breast cancer, having a WLE followed by radiotherapy is as effective as mastectomy. You’ll need to have radiotherapy after a WLE to make sure any remaining cancer cells are treated. If the cancer is very small, you may need a fine wire to mark the area so the surgeon can find it more easily. This is called wire localisation.

After a WLE, most women are pleased with the appearance of their breast.

Removing a larger area of breast tissue

Some women need to have a larger area of breast tissue removed (sometimes called a quadrantectomy).

Surgeons can use different techniques to help improve the appearance of your breast if you need a lot of tissue removed. They may reshape the breast by moving the breast tissue around and reducing it in size. This type of surgery is sometimes called therapeutic mammoplasty. They may suggest you have the other breast reduced at the same time or later so both breasts are the same size.

Occasionally, they take tissue from somewhere else in the body to help reshape the breast. This is usually if you have a small breast and it’s not possible to get a good appearance using mammoplasty.

We have more information about breast reconstruction for women having breast-conserving surgery and surgery to reshape the breast.

Clear margins

After breast-conserving surgery, the pathologist examines the tissue in the area (margin) around the cancer. If there are cancerous or pre-cancerous cells (DCIS) at the edges, you will need another operation to remove more tissue. Making sure the margins are clear reduces the risk of the cancer coming back in the breast. If your surgeon doesn’t think another operation is likely to be successful, they usually recommend a mastectomy.


Removing the breast (mastectomy)

Breast surgeons will usually try to conserve a woman’s breast whenever possible. But there are situations when they may recommend mastectomy. This may be when:

  • the lump is large in proportion to the rest of your breast
  • there are areas of cancer in different parts of the breast
  • there is widespread DCIS in the breast
  • you have had radiotherapy to the chest before to treat another cancer, such as Hodgkin lymphoma.

Breast reconstruction

If you are having a mastectomy, your surgeon will usually ask if you want a new breast shape made at the same time (immediate breast reconstruction). You can also choose to delay reconstruction until after you’ve completed treatments such as radiotherapy and chemotherapy.

If you’re not having immediate reconstruction but think you might want to have breast reconstruction in the future, it’s a good idea to mention this before you have a mastectomy. You don’t have to make a definite decision at this stage, but it will help the surgeon to plan your initial surgery.

Breast reconstruction is specialised surgery carried out either by a plastic surgeon or oncoplastic surgeon (experts in breast cancer surgery and reconstruction). There are different methods of reconstruction. A new breast shape can be made using a silicone implant or with fat, and sometimes muscle from your back or tummy.

We have more information about breast reconstruction.


Choice of treatment for breast cancer

The chances of surviving early breast cancer are similar with breast-conserving surgery and radiotherapy, or a mastectomy. Your surgeon and nurse may ask you to choose the operation you feel suits you best.

Making treatment decisions can be difficult. It’s important to talk it over carefully with your surgeon and breast care nurse. Make sure you have the information you need to feel confident in making the right decision for you. You will probably also want to talk it over with a partner (if you have one), family and close friends.

It’s helpful to think about the possible advantages and disadvantages of both of these treatments before making a decision. We have more information about making treatment decisions. You can also call the Macmillan Support Line to talk to one of our cancer support specialists.

Breast-conserving surgery and radiotherapy

Advantages

  • It keeps the appearance and sensation of the breast.
  • Recovery is shorter and easier than with a mastectomy.
  • It may be less likely to affect your sex life and relationships.

Disadvantages

  • You may need more than one operation to get clear margins.
  • You need three weeks of radiotherapy after the surgery (some women will need radiotherapy after mastectomy).
  • Radiotherapy has short-term side effects, and some women may have long-term side effects.
  • You may still worry about the cancer coming back in the breast.

Mastectomy

Advantages

  • You may not need radiotherapy. However, some women still need it after mastectomy, so ask your cancer specialist about this.
  • You may feel less anxious as all the breast has been removed.

Disadvantages

  • You lose your breast permanently.
  • It takes longer to recover after having a mastectomy.
  • It changes your appearance, which may affect your confidence, sex life and relationships.
  • You will need a longer operation and possibly further surgery if you want breast reconstruction afterwards. However, reconstruction may help to reduce disadvantages for some women.


Surgery to the lymph nodes

Your surgeon may remove some or all of the lymph nodes in your armpit to check them for cancer cells. This serves two purposes:

  • It gets rid of any cancerous lymph nodes–(you may need more treatment if only some nodes were removed).
  • It gives information about the stage of the cancer, which helps when making decisions about having other treatments.

There are different types of lymph node surgery.


Sentinel lymph node biopsy (SLNB)

This may be done if you had a small cancer and the ultrasound of your armpit was 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 reduces the risk of side effects that can 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 injects 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 also injects 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), which are tested to see if they contain cancer cells.


Removing some lymph nodes (sampling)

Sometimes the surgeon removes four or more lymph nodes in the armpit. This is called sampling.  You may have it done with a blue dye injection (see SLNB above).

If any nodes from the SLNB or sampling contain cancer cells, you will usually have another operation to remove the remaining lymph nodes. Some women have radiotherapy to the rest of the lymph nodes instead of more 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). It gets rid of any nodes that contain cancer cells. If you have ALND, you won’t need radiotherapy to the nodes afterwards.

An ALND is usually done when:

  • the lymph node ultrasound is abnormal
  • the fine needle aspiration (FNA) of the lymph nodes is positive
  • the SLNB or sampling shows there are cancer cells in the nodes.

There’s an increased risk of developing swelling of the arm called lymphoedema after having an ALND. We have more information about lymphoedema and taking care of your arm.


Back to Surgery explained

What is surgery and what is it used for?

Surgery is cutting away body tissue. It is used to treat lots of types of cancer.

What happens before surgery?

You will have some tests and a chance to talk about any concerns you have before your surgery.

What happens after surgery?

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

Follow-up care after surgery

You will have follow-up appointments after your surgery to check on your recovery and any new symptoms.