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Surgery

Most women with breast cancer will have surgery. The two common types of surgery are breast-conserving surgery and mastectomy.

A lumpectomy removes only the breast lump and the surrounding area, or margin, of normal tissue. If cancer cells are present at the margin (the edge of the excisional biopsy or lumpectomy tissue), an excision can usually be done again to remove the remaining cancer.

In almost all cases of invasive breast cancer, radiation therapy is given after a lumpectomy. Doctors call this combination (of lumpectomy and radiation) breast-conserving therapy. It’s an option for most, but not all, women with breast cancer. Those who probably should not have lumpectomy, or breast-conserving therapy include:

  • Women who have already had radiation therapy to the affected breast or chest.
  • Women with two or more areas of cancer, in the same breast, too far apart to be removed in one incision.
  • Women whose first surgery, or when needed, their re- excision, has not completely removed their cancers.
  • Women whose tumor is larger than 5 centimeters (2 inches) and can’t be shrunk by treatment before surgery.
  • Women with active connective tissue diseases involving the skin (especially scleroderma or lupus) that make body tissues specially sensitive to the side effects of radiation.
  • Pregnant women who would require radiation while still pregnant.

Mastectomy

In a simple (total) mastectomy procedure surgeons remove the entire breast but do not remove any lymph nodes from under the arm, or muscle tissue from beneath the breast. This procedure is used to treat noninvasive (in situ) breast cancer. In a modified radical mastectomy, surgeons remove the entire breast and some axillary (underarm) lymph nodes.
The possible short-term side effects of both mastectomy and lumpectomy include: wound infection, hematoma (collection of blood in the wound), and seroma (collection of clear fluid in the wound)

Lymph Node Surgery

Whether a woman has a mastectomy or a lumpectomy for invasive cancer, she and her doctor usually need to know if the cancer has spread to the lymph nodes. If the lymph nodes are affected, that increases the likelihood that cancer cells have spread through the bloodstream to other parts of the body. Women with pure ductal carcinoma in situ or pure lobular carcinoma in situ do not necessarily need lymph node testing.

Options include sentinel lymph node surgery which is a minimally invasive procedure that samples the “first” node or the initial lymph nodes that drain the breast tissue to determine if there is any spread of cancer from the breast. The alternative method to examine the lymph nodes is a full axillary dissection which removes many lymph nodes and is a more extensive surgery.