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 For example, surgery may be done to:
Remove as much of the cancer as possible (breast-conserving surgery
or mastectomy)
Find out whether the cancer has spread to the lymph nodes under the
arm (sentinel lymph node biopsy or axillary lymph node dissection)
Restore the breast’s shape after the cancer is removed (breast
reconstruction)
Relieve symptoms of advanced cancer
Your doctor may recommend a certain operation based on your breast
cancer features and your medical history, or you may have a choice
about which type to have. It’s important to know your options so you
can talk about them with your doctor and make the choice that is
right for you.
Surgery to remove breast cancer
There are two main types of surgery to remove breast cancer:
Breast-conserving surgery (also called a lumpectomy,
quadrantectomy, partial mastectomy, or segmental mastectomy) is a
surgery in which only the part of the breast containing the cancer
is removed. The goal is to remove the cancer as well as some
surrounding normal tissue. How much breast is removed depends on
where and how big the tumor is, as well as other factors.
Mastectomy is a surgery in which the entire breast is
removed, including all of the breast tissue and sometimes other
nearby tissues. There are several different types of mastectomies.
Some women may also get a double mastectomy, in which both breasts
are removed.
Choosing between breast-conserving surgery and mastectomy
Many women with early-stage cancers can choose between
breast-conserving surgery (BCS) and mastectomy. The main advantage
of BCS is that a woman keeps most of her breast. But in most cases
she will also need radiation. Women who have mastectomy for
early-stage cancers are less likely to need radiation.
For some women, mastectomy may be a better option, because of the
type of breast cancer, the large size of the tumor, previous
treatment with radiation, or certain other factors.
Some women might worry that having a less extensive surgery might
raise their risk of the cancer coming back. But studies following
thousands of women for more than 20 years show that when BCS is done
with radiation, survival is the same as having a mastectomy in
people who are candidates for both types of surgery.
Surgery to remove nearby lymph nodes
To find out if the breast cancer has spread to underarm (axillary)
lymph nodes, one or more of these lymph nodes will be removed and
looked at in the lab. This is an important part of figuring out the
stage (extent) of the cancer. Lymph nodes may be removed either as
part of the surgery to remove the breast cancer or as a separate
operation.
The two main types of surgery to remove lymph nodes are:
Sentinel lymph node biopsy (SLNB) is a procedure in which the
surgeon removes only the lymph node(s) under the arm where the
cancer would likely spread first. Removing only one or a few lymph
nodes lowers the risk of side effects from the surgery, such as arm
swelling that is also known as lymphedema.
Axillary lymph node dissection (ALND) is a procedure in which
the surgeon removes many (usually less than 20) underarm lymph
nodes. ALND is not done as often as it was in the past, but it might
still be the best way to look at the lymph nodes in some situations.
To learn more about these procedures, see
Lymph Node Surgery for Breast Cancer.
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Breast reconstruction after surgery
Many woman having surgery for breast cancer might have the option of
breast reconstruction. A woman having a mastectomy might want to
consider having the breast mound rebuilt to restore the breast’s
appearance after surgery. In some breast-conserving surgeries, a
woman may consider having fat grafted into the affected breast to
correct any dimples left from the surgery. The options will depend
on each woman’s situation.
There are several types of reconstructive surgery, but your options
may depend on your medical situation and personal preferences. You
may have a choice between having breast reconstruction at the same
time as the breast cancer surgery (immediate reconstruction) or at a
later time (delayed reconstruction).
If you are thinking about having reconstructive surgery, it’s a good
idea to discuss it with your breast surgeon and a plastic surgeon
before your mastectomy or BCS. This gives the surgical team time to
plan out the treatment options that might be best for you, even if
you wait and have the reconstructive surgery later.
To learn about different breast reconstruction options, see our
section on
Breast Reconstruction Surgery.
Surgery for advanced breast cancer
Although surgery is very unlikely to cure breast cancer that has
spread to other parts of the body, it can still be helpful in some
situations, either as a way to slow the spread of the cancer, or to
help prevent or relieve symptoms from it. For example, surgery might
be used:
When the breast tumor is causing an open wound in the breast (or
chest)
To treat a small number of areas of cancer spread (metastases) in a
certain part of the body, such as the brain
When an area of cancer spread is pressing on the spinal cord
To treat a blockage in the liver
To provide relief of pain or other symptoms
If your doctor recommends surgery for advanced breast cancer, it’s
important that you understand whether it’s to try to cure the cancer
or to prevent or treat symptoms.
Wire localization to guide surgery
Sometimes, if the cancer in your breast can’t be felt, is hard to
find, and/or is difficult to get to, the surgeon might use a
mammogram or ultrasound to guide a wire to the right spot. This is
called wire localization or needle localization. If a mammogram is
used you may hear the term stereotactic wire localization. Rarely,
MRI might be used if the mammogram or ultrasound are not successful.
After your breast is numbed, a mammogram or ultrasound is used to
guide a thin hollow needle to the abnormal area. Once the tip of the
needle is in the right spot, a thin wire is put in through the
center of the needle. A small hook at the end of the wire keeps it
in place. The needle is then taken out. The surgeon uses the wire as
a guide to find the part of the breast to be removed.
The surgery done as part of the wire localization may be enough to
count as breast-conserving surgery if all of the cancer is taken out
and the margins are negative. If cancer cells are found at the edge
of the removed tissue (also called a positive or close margin), more
surgery may be needed.
It should be noted that a wire-localization procedure is sometimes
used to perform a surgical biopsy of a suspicious area in the breast
to find out if it is cancer or not.
There are other ways a surgeon can be guided to the tumor, but these
techniques are newer and not used in every facility.
[The American Cancer Society medical
and editorial content team]
Our team is made up of doctors and oncology certified nurses with
deep knowledge of cancer care as well as journalists, editors, and
translators with extensive experience in medical writing. |
