Breast Cancer Surgery

Breast cancer surgery types

The two main types of surgery are:

Lumpectomy

This is considered breast-conserving surgery, removing as little breast tissue as possible. The goal is to only remove the cancer and a rim of surrounding tissue. During the procedure, your surgeon may also do a sentinel lymph node biopsy (removing only the first nodes which could be involved with cancer) or in some cases a lymph node dissection, to further determine whether the cancer has spread to the lymph nodes. Radiation therapy is usually recommended after a lumpectomy to reduce the risk of developing cancer in the remaining breast tissue.

Mastectomy

These days it is rare to need a radical mastectomy, which involves removal of the entire breast as well as the breast skin, lymph nodes and underlying muscle. Modern mastectomy procedures include:

• Simple (total) mastectomy – breast tissue, nipple, areola and skin removed
• Modified radical – breast tissue, nipple, areola, skin and axillary lymph nodes removed
• Skin-sparing – breast, nipple, areola and sentinel lymph nodes removed, but not the rest of the breast skin
• Nipple-sparing – breast tissue and sentinel lymph nodes removed, but no skin is removed (nipple and areola are saved)

Depending on the type of surgery you're having, you may also want to have breast reconstruction surgery, which may be performed during the initial surgery.

Other types of breast surgery

Prophylactic mastectomy

Women who are at high risk for developing breast cancer due to an inherited genetic defect such as BRCA1 or BRCA2, or strong family history of breast cancer, may consider a prophylactic (risk-reducing) mastectomy to remove one or both breasts before cancer develops. A prophylactic mastectomy can greatly reduce (but not totally eliminate) the chance of developing breast cancer.

Breast reconstruction after surgery

If you have had a mastectomy or lumpectomy you may be interested in having one or both breasts reconstructed. This surgical procedure can alter the size, shape, appearance and symmetry of the breasts, and in many cases, can help you feel more comfortable and confident after the loss of a breast or portion of the breast.

If you need reconstruction for only one breast, you may also choose to have a breast lift, breast augmentation or breast reduction of the second breast in order to create a more even appearance.

Breast reconstruction surgery is often done in conjunction with a mastectomy or lumpectomy. Your doctor will help you consider your options and whether it may be advisable to postpone breast reconstruction until you are finished with other treatments such as radiation therapy.

The two types of breast reconstruction are implant and flap, or some combination of the two. For an implant reconstruction, the surgeon may use an "expander" to gently "grow" the breast to the desired size prior to inserting a permanent implant. Flap, or autologous reconstruction, uses skin, muscle and fat from your own belly, back or buttocks, to "build" a new breast.

Hidden Scar breast surgery

With a Hidden Scar approach, your surgeon will place your incision in a location that is hard to see, so that the scar is not visible when your incision heals. The Hidden Scar approach can be performed for a nipple-sparing mastectomy or a lumpectomy. Options for Hidden Scar breast cancer surgery will be determined based on the size and location of your tumor, your breast shape and your breast size.