Breast surgery

Surgery is usually the first line of attack against breast cancer. This page describes the different types of breast cancer surgery that are offered. Your care team will determine the surgery that is most appropriate for you based on the type and stage of cancer, and what is most acceptable to you.

Lumpectomies

A lumpectomy is a form a breast-conserving surgery because, unlike a mastectomy, only a portion of the breast is removed. The goal is to remove cancer while maintaining the appearance of your breast. A small amount of normal tissue around the lump (called clear margins) is also removed to help ensure that all the cancer is removed. The amount of tissue removed can very greatly. For example, a quadrantectomy means roughly one-quarter of the breast will be removed.

Studies show that lumpectomy is as effective a treatment as removal of the entire breast. Your care team may recommend lumpectomy if:
  • Your biopsy confirms you have cancer, and the cancer is small and early-stage, for which breast-conserving surgery is a viable option
  • You have a noncancerous (benign) breast mass that warrants removal

Mastectomy (Simple or Total)

In a simple or total mastectomy the surgeon removes the entire breast. No muscles are removed from beneath the breast. The goal of total mastectomy is to remove all breast tissue, as physically removing the tumor is the single most effective treatment for breast cancer. You may have a mastectomy in one or both breasts. Modified radical and radical are two variants of this surgery. In a modified radical mastectomy, axillary lymph node dissection is also performed. This allows the lymph nodes to be examined, which helps identify whether cancer cells have spread beyond the breast. In a radical mastectomy, the surgeon also removes the chest wall muscles under the breast. This is a less common procedure because in most cases, modified radical mastectomy has been proven to be as effective and less disfiguring.

Skin-sparing Mastectomy with Immediate Reconstruction

A skin-sparing mastectomy is another form of breast-conserving surgery that saves the breast skin and causes much less scarring than a traditional mastectomy. The procedure removes the cancerous tissue through a small incision around the areola area of the nipple. All of the breast skin (except the nipple and areola) is saved, leaving a natural skin envelope or pocket that the plastic surgeon can then fill with a breast implant or with the patient’s tissue from another part of her body. This technique gives the best option for reconstruction.

Subcutaneous (and Nipple-sparing) Mastectomy

During this type of mastectomy, the incision is made under the breast, leaving the skin, areola and nipple intact. This type of mastectomy leaves more tissue behind, due to working through the incision under the breast. Because of this it is not considered appropriate for all conditions. Nipple-sparing mastectomy completely removes the areola/nipple from the breast, scrapes it clean of tissue, and regrafts onto the breast.

Prophylactic (Preventive) Mastectomy

Prophylactic mastectomy is surgery to remove one or both breasts in the hopes of preventing or reducing the risk of breast cancer. Certain factors increase the risk significantly, such as:
  • Already had cancer in one breast
  • A family history of breast cancer
  • Positive results from gene testing
  • Early signs of cancer in your breast
  • Radiation therapy
  • Dense breasts and strong family history or precancerous conditions
Remember that having a higher risk of developing cancer doesn’t mean that you’ll get cancer. Work with your care team to get a complete evaluation of your risk and options.