Breast cancer surgery is a key component of breast cancer treatment that involves removing the cancer with an operation. Breast cancer surgery may be used alone or in combination with other treatments, such as chemotherapy, hormone therapy, targeted therapy and radiation therapy.
For people with a very high risk of breast cancer, breast cancer surgery may be an option to reduce the risk of future breast cancer.
Breast cancer surgery includes different procedures, such as:
- Surgery to remove the entire breast (mastectomy)
- Surgery to remove a portion of the breast tissue (lumpectomy)
- Surgery to remove nearby lymph nodes
- Surgery to reconstruct a breast after mastectomy
Which breast cancer operation is best for you depends on the size and stage of your cancer, your other treatment options, and your goals and preferences.
Why it's done
Watch Mayo Clinic breast surgeons discuss breast cancer surgery on YouTube
During a total (simple) mastectomy, the surgeon removes the breast tissue, nipple, areola and skin. Other mastectomy procedures may leave some parts of the breast, such as the skin or the nipple. Surgery to create a new breast is optional and can be done at the same time as your mastectomy surgery or it can be done later.
A nipple-sparing mastectomy involves removal of the breast tissue, but spares the skin, nipple and areola. This illustration shows two examples of common incisions used for the procedure, though your surgeon will determine the approach that's best for your particular situation. Dissolvable stitches are placed under the skin so they won't need to be removed later.
A lumpectomy involves removing the cancer and some of the healthy tissue that surrounds it. This illustration shows one possible incision that can be used for this procedure, though your surgeon will determine the approach that's best for your particular situation.
The goal of breast cancer surgery is to remove cancer cells from your breast. For those who choose breast reconstruction, a procedure to place breast implants or reconstruct a breast from your own tissue (flap surgery) may be done at the same time or in a later operation.
Breast cancer surgery is used to treat most stages of breast cancer, including:
- A high risk of breast cancer. People with a high risk of breast cancer based on a strong family history of the disease, certain noncancerous breast biopsy results or a gene mutation might consider preventive (prophylactic) mastectomy with or without immediate breast reconstruction as an option to prevent breast cancer.
- Noninvasive breast cancer. People diagnosed with ductal carcinoma in situ (DCIS) may undergo lumpectomy, which may be followed by radiation therapy, though mastectomy with or without breast reconstruction may also be an option.
- Early-stage breast cancer. Small breast cancers may be treated with lumpectomy or mastectomy with or without breast reconstruction followed by radiation and, sometimes, chemotherapy, hormone therapy or targeted therapy.
- Larger breast cancers. Larger cancers may be treated with mastectomy, though sometimes chemotherapy, hormone therapy or targeted therapy is used before surgery to make it possible to perform a lumpectomy. Additional treatment with radiation therapy, chemotherapy, hormone therapy or targeted therapy may be recommended.
- Locally advanced breast cancers. Breast cancers that are very large or have spread to several lymph nodes are often treated first with chemotherapy, hormone therapy or targeted therapy to shrink the tumor and make surgery more successful. These cancers may be removed using mastectomy or lumpectomy, followed by radiation therapy.
- Recurrent breast cancer. Breast cancer that returns after initial treatment may be removed with additional surgery. Additional treatments may be recommended.
Surgery is seldom used to treat breast cancer that spreads to other parts of the body (metastatic breast cancer).
Breast cancer surgery is a safe procedure, but it carries a small risk of complications, including:
- Collection of fluid at the operative site (seroma)
- Permanent scarring
- Loss of or altered sensation in the chest and reconstructed breasts
- Wound healing problems
- Arm swelling (lymphedema)
- Risks related to the medicine (anesthesia) used to put you in a sleep-like state during surgery, such as confusion, muscle aches and vomiting
How you prepare
Discuss your options with a breast cancer surgeon
Your initial meeting with a breast cancer surgeon can help you understand your treatment options and what you can expect from surgery. Prepare for this meeting by creating a list of questions to ask, such as:
- Which operations are best for my particular case?
- Does each option offer the same chance for breast cancer cure?
- How much of my breast needs to be removed?
- Should my healthy breast be removed at the same time?
- How many operations will I need?
- What are my options for reconstruction?
- Can the reconstruction be started at the same time as my cancer surgery?
- How will my breast look after surgery? Will my breasts look the same?
- Can you show me pictures of other people that have undergone these procedures?
- If I choose to forgo reconstruction, what will my breast look like?
- Is surgery safe for me?
- How much time will I spend in the hospital?
- How much time will I need for recovery? When can I return to work?
- How many breast cancer surgeries have you done?
- If you had a family member in my situation, what would you recommend?
Breast cancer surgeons work closely with plastic surgeons who do breast reconstruction. If you're planning to undergo breast reconstruction, make an appointment to discuss these options, too.
What you can expect
Nipple-sparing mastectomy, pre-pectoral reconstruction
Amy Degnim, M.D., General Surgery, Mayo Clinic: We are able to achieve really wonderful cosmetic results with this procedure.
Jeff Olson: Breast cancer surgeon, Dr. Amy Degnim says the first phase of this team procedure is nipple-sparing mastectomy, to remove cancerous breast tissue but if possible save all the skin including the nipple and areola.
Dr. Degnim: So that after a reconstruction the result looks as natural as possible.
Jeff Olson: The natural look is furthered during the second phase of the surgery: Pre-pectoral reconstruction.
Valerie Lemaine, M.D., Plastic Surgery, Mayo Clinic: Once we know that clear margins have been obtained, then I'm called into the operating room.
Jeff Olson: Plastic surgeon Dr. Valerie Lemaine says unlike traditional reconstruction with the implant behind the chest muscle, in a pre-pectoral procedure the implant goes in front.
Dr. Lemaine: The main advantage is the implant is positioned where the breast used to be anatomically. Also, when we do surgery without manipulating a muscle, there is definitely less pain.
Dr. Degnim: We want women to know that this is an option for many of them.
Jeff Olson: For the Mayo Clinic News Network, I'm Jeff Olson.
Sentinel node biopsy
Sentinel node biopsy identifies the first few lymph nodes into which a tumor drains. The surgeon uses a harmless dye and a weak radioactive solution to locate the sentinel nodes. The nodes are removed and tested for signs of cancer.
Pre-pectoral breast implant
In pre-pectoral breast implant placement, the implant is placed on top of the chest (pectoralis) muscle. After mastectomy, a balloonlike tissue expander can be placed between your chest muscle and your skin. The tissue expander is gradually filled with saline to stretch the breast skin and make room for a breast implant. To support your breast skin, the surgeon may insert a layer of collagen cells (tissue matrix) around the expander. Over time, your own cells fill in the matrix to create supportive tissue to hold the implant in place. You will need a second surgery to exchange the tissue expander for a permanent implant.
During a deep inferior epigastric perforator (DIEP) flap procedure, the surgeon removes a section of abdominal skin and fat, along with the associated blood vessels. Using complex microsurgical techniques, the blood vessels are attached to the ones in your chest and the skin and fat are used to create a breast.
During breast cancer surgery
Breast cancer surgery is done in a hospital. Before the procedure, you're given medicine (general anesthesia) that keeps you in a sleep-like state.
What happens during your surgery will depend on the operation, but you can expect:
- An incision in your breast to remove cancer and surrounding tissue. How much tissue is removed will depend on whether you undergo lumpectomy to remove part of the breast tissue or mastectomy to remove all of the breast tissue. The placement and length of the incision depends on the location of the cancer within the breast.
An assessment of the lymph nodes in your armpit. During a sentinel node biopsy, the surgeon removes a few lymph nodes into which a tumor is most likely to drain first (sentinel nodes). These are then tested for cancer. If no cancer is present, no additional lymph nodes need to be removed.
If cancer is found, the surgeon may remove more lymph nodes or recommend radiation therapy to your lymph nodes after surgery. Sometimes both lymph node treatments are combined.
- Closure of the incision. The surgeon closes the incision with attention to your appearance. Dissolvable stitches are placed to reduce scarring.
- Reconstruction, if you choose. If you are undergoing mastectomy and choose breast reconstruction, the reconstruction is most frequently started at the time of your cancer operation. In some cases, reconstruction may be delayed and done in a separate surgery.
After breast cancer surgery
After your surgery, you can expect to:
- Be taken to a recovery room where your blood pressure, pulse and breathing are monitored
- Have a dressing (bandage) over the surgery site
- Possibly have pain, numbness and a pinching sensation in your underarm area
- Receive instructions on how to care for yourself at home, including taking care of your incision and drains, recognizing signs of infection, and understanding activity restrictions
- Talk with your health care team about when to resume wearing a bra or wearing a breast prosthesis
- Be given prescriptions for pain medication and possibly an antibiotic
- Resume your regular diet
- Shower the day after surgery
Expect to spend one night in the hospital after mastectomy if you also undergo breast reconstruction. Those undergoing mastectomy without reconstruction or lumpectomy may leave the hospital the day of surgery.
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Oct. 10, 2020