Breast Cancer Surgery

Breast cancer as experienced by woman during the early stages of the disease (DCIS or Stage I, IIA, IIB, or IIIA breast cancer) means that such patients may be able to choose which type of breast cancer surgery to have. Often, the choice is between breast-sparing surgery (surgery that takes out the cancer and leaves most of the breast) and a mastectomy (surgery that removes the whole breast). Research shows that women with early-stage breast cancer who have breast-sparing surgery along with radiation therapy live as long as those who have a mastectomy. Most women with breast cancer will lead long, healthy lives after treatment.

Breast cancer treatment usually begins a few weeks after diagnosis. In these weeks, you should meet with a surgeon, learn the facts about your surgery choices, and think about what is important to you. Then choose which kind of surgery to have. Most women want to make this choice. After all, the kind of surgery you have will affect how you look and feel. But it is often hard to decide which form of breast cancer treatment to choose.

Any form of surgery that removes only part of the breast is considered “breast-conserving” or “breast preservation” surgery. You may hear your surgeon use any one of several names: biopsy, lumpectomy, partial mastectomy, re-excision, quadrantectomy, wedge resection. Technically, a lumpectomy is a partial mastectomy, because part of the breast is removed. But how much of the breast is removed can vary greatly. Quadrantectomy, for example, means that a quarter of your breast will be removed. Be sure your surgeon discusses his or her “plan of action” with you, so that you have a clear understanding of how much of your breast may be gone after breast cancer surgery.

Lumpectomy is the most common form of breast cancer surgery today. The surgeon removes only the part of your breast containing the tumor (the “lump”) and some of the normal tissue that surrounds it. Read more about recommended treatments after lumpectomy. All the tissue removed from your breast is examined carefully to see if cancer cells are present in the margins—the normal tissue surrounding the tumor. Read an article about radiation after lumpectomy.

If cancer cells are found in the margins, extending out to the edge of the breast tissue that was removed, your surgeon will do additional surgery (called re-excision) to remove the remaining cancer. Most women receive five to seven weeks of radiation therapy after lumpectomy, in order to eliminate any cancer cells that may be present in the remaining breast tissue.

The combination of lumpectomy and radiation is commonly called breast-conserving therapy.

Meanwhile, in a “simple” or “total” mastectomy, the surgeon removes the entire breast but does not take out any axillary lymph nodes (nodes in the underarm area, also called the axilla). No muscles are removed from beneath your breast in a mastectomy. Occasionally, lymph nodes may be removed because they are actually located within the breast tissue taken during surgery. A total mastectomy is appropriate for women with ductal carcinoma in situ or DCIS, and for women who are seeking prophylactic mastectomies—that is, breast removal in order to prevent any possibility of breast cancer occurring. In any event it is advisable to weigh up the various types of breast cancer surgery available before making a decision about which is the best one for you.

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