1. Surgery for breast cancer treatment
2. Which type of surgery will I have?
3. Breast-conserving surgery: lumpectomy or wide local excision
7. Breast reconstruction
8. The unaffected breast
9. Prostheses, bras and clothing after a mastectomy
10. The right surgery for you
11. Surgery to the lymph nodes
12. Going into hospital and pre-assessment
Surgery is the first treatment for most people with breast cancer.
The two main types of breast surgery are:
- breast-conserving surgery: the cancer is removed along with a margin (border) of normal breast tissue
- mastectomy: all the breast tissue is removed.
Surgery can also be carried out to the lymph nodes.
You can find out more about going into hospital for surgery in our booklet Your operation and recovery.
The type of surgery recommended for you will depend on several factors, such as the type and size of the cancer and where it is in the breast. Your specialist team will explain why they think a particular operation is best for you.
You may be offered a choice between having breast-conserving surgery or a mastectomy.
Find out more about the right surgery for you.
A lumpectomy is surgery to remove breast cancer along with a margin (border) of normal, healthy breast tissue.
A lumpectomy is a type of breast-conserving surgery, also known as a wide local excision.
The aim is to keep as much of your breast as possible, while ensuring the cancer has been completely removed.
If you’re having breast-conserving surgery, you’ll usually have radiotherapy on the remaining breast tissue on that side.
A far less common operation is a quadrantectomy, where around a quarter of the breast is removed. This is sometimes called a segmental excision.
After a quadrantectomy the treated breast will usually be smaller due to the amount of tissue removed and it may also be misshapen. However, oncoplastic surgical techniques, which combine breast cancer surgery with plastic surgery, are increasingly used. This means it’s less likely you’ll notice a dent or a great difference between the breasts.
It’s important that the cancer is removed with an area (margin) of healthy breast tissue around it to make sure no cancer cells have been left behind.
The breast tissue removed during surgery will be tested to check the margin around the cancer.
- Negative (clear) margins mean no cancer cells were seen at the outer edge of the tissue removed.
- Positive margins mean the cancer cells are very close to or reach the edge of the tissue.
If you have negative or clear margins, it’s unlikely you’ll need more surgery to the breast.
If there are cancer cells at the edges of the margin, you may need further surgery to remove more tissue. Some people may need a mastectomy to ensure all the cancer has been removed.
A mastectomy is surgery to remove a breast.
A simple mastectomy is the removal of all the breast tissue, including the skin and nipple area.
Examples of when a mastectomy may be recommended include:
- breast cancer takes up a large area of the breast
- there’s more than one area of cancer in the breast.
If your surgeon recommends a mastectomy they should explain why. It may also be your personal preference to have a mastectomy.
If you’re going to have a mastectomy, your breast surgeon will discuss breast reconstruction with you.
If you’re going to have a breast reconstruction at the same time as the mastectomy (immediate breast reconstruction), your breast surgeon may discuss other types of mastectomy. This will depend on your individual situation.
A skin-sparing mastectomy is removal of the breast and nipple area without removing much of the overlying skin of the breast.
Some women who are having a mastectomy wonder whether they should have their unaffected breast removed as well.
Evidence shows this is not usually necessary or recommended, unless someone has a higher risk of developing primary breast cancer in the other side. This might be the case if they have inherited an altered gene or have a strong family history of breast cancer.
Many women overestimate their risk of developing a new primary cancer in the other breast or mistakenly believe breast cancer can spread from one breast to the other, so it’s important to discuss your individual situation with your surgeon.
9. Prostheses, bras and clothing after a mastectomy
You may like to read our information about:
- breast prostheses – artificial breast forms used to restore shape after surgery
- finding a bra after a mastectomy
- clothing and swimwear.
The type of breast surgery that’s recommended for you will depend on a number of factors.
- the type of breast cancer
- the size of the cancer
- where it is in the breast
- whether more than one area of the breast is affected
- how much surrounding tissue needs to be removed
- the size of your breast.
Your specialist team will explain why they think a particular operation is best for you.
If you’re offered a choice
Some people will be offered a choice between breast-conserving surgery and a mastectomy.
Long-term survival is the same for breast-conserving surgery followed by radiotherapy as for mastectomy.
Studies show that women who have a wide local excision may be slightly more likely to have a local recurrence (where breast cancer returns in the same breast), which can be treated again. However, most people don’t have a recurrence.
You may want to look at a decision-making tool, such as Option Grid, to help you decide which operation is best for you.
Talk to someone
You may find it helpful to talk through your choices with your breast care nurse.
Questions you might want to ask your specialist team about your surgery include:
- What surgery will I need and why?
- Where will the scars be?
- What will my breast area look like after surgery?
- What side effects can I expect?
- How long will I take to recover?
- Can I see photographs of people who have had breast surgery?
- Can I see some breast prostheses (artificial breast forms)?
You can also call Breast Cancer Care’s Helpline on 0808 800 6000.
Breast cancer cells can sometimes spread to the lymph nodes under the arm.
Anyone with invasive breast cancer will have the lymph nodes under the arm assessed. The outcome of this will help the specialist team recommend which treatments are best for you.
The lymph nodes
Breasts contain a network of tiny tubes called lymph vessels. These are connected to the lymph nodes (glands) under the arm.
Lymph nodes are arranged in three levels, and the exact number of nodes in each level varies from person to person.
The above is a basic illustration of the different levels of lymph nodes. Where the lymph nodes are situated and how many lymph nodes you have will vary according to each person.
If you have invasive breast cancer, your specialist team will want to check if any of the lymph nodes under the arm contain cancer cells. This helps them decide whether you’ll benefit from additional treatment after surgery.
Usually an ultrasound scan of the underarm (known as the axilla) is done before surgery to assess the lymph nodes.
If this appears abnormal, you’ll have a fine needle aspiration (FNA) or a core biopsy to see if the cancer has spread to the lymph nodes. An FNA uses a fine needle and syringe to take a sample of cells to be looked at under a microscope. A core biopsy uses a hollow needle to take a sample of tissue for analysis under a microscope.
Lymph node removal
If the FNA or core biopsy shows cancer has spread to the lymph nodes you’ll usually be recommended to have all or most of your lymph nodes removed at the same time as your breast surgery. This is known as an axillary clearance.
If the tests before surgery show no evidence of the lymph nodes containing cancer cells, you usually still need to have a sample of the lymph nodes removed to confirm this. This is known as axillary sampling.
Sentinel lymph node biopsy is widely used for axillary sampling. It identifies whether or not the first, or sentinel, lymph node (or nodes) is clear of cancer cells. The sentinel node is usually in level 1.
Before your breast cancer surgery, your doctor will inject a small amount of radioactive liquid into the breast, close to the cancer. This may be done just before your operation or the day before.
During the operation, your surgeon injects a small amount of blue dye into the breast. The radioactive liquid and the dye drain away from the breast tissue into the lymph node(s) closest to the area. The sentinel node(s) is then removed and examined under a microscope to see if it contains any cancer cells.
As the dye leaves your body, you may notice your urine is a bluish-green colour for one or two days after the procedure. The skin around the biopsy site may also be stained a blue-green colour. Some people may have a reaction to the dye but this is rare.
If the sentinel node(s) does not contain cancer cells, this usually means the other nodes are clear too, so no more will need to be removed.
If the results show there are cancer cells in the sentinel node(s) you may be recommended to have further surgery or radiotherapy to the remaining lymph nodes.
If you’re having chemotherapy before your surgery, your specialist may want you to have a sentinel lymph node biopsy before starting chemotherapy. This can help with planning any further treatment to the underarm after chemotherapy.
Isolated tumour cells (ITCs), micrometastases and macrometastases
Your doctor may use one of these terms when discussing your sentinel lymph node biopsy result.
- ITCs are single cancer cells or small clusters of cells no bigger than 0.2mm.
- Micrometastases are cancer cells larger than 0.2mm but not bigger than 2mm
- Macrometastases are cancer cells larger than 2mm.
If you’re diagnosed with ITCs or micrometastases, you will not usually need any further treatment to your axilla (under the arm).
If you have one or two sentinel nodes with macrometastases, you may or may not need further treatment to your axilla. This will depend on several factors including other characteristics of the cancer, for example what the grade is and whether you’re having hormone therapy. Your doctors may talk about going into a clinical trial that is comparing treating versus not treating the axilla.
If you have three or more sentinel nodes with macrometastases, you will need further treatment to the axilla.
Assessing lymph nodes during surgery
Some hospitals have the facility to assess the lymph nodes during breast surgery. The removed nodes will be looked at by a pathologist, who will tell the surgeon the result during the operation.
If the sentinel node(s) contains cancer cells, the surgeon will then remove more or all of the lymph nodes. Having lymph nodes assessed during surgery avoids a second operation. The most common test used is called One Step Nucleic Acid Amplification (OSNA).
Before you’re given a general anaesthetic (which you’ll normally have if you’re having breast surgery) your overall health will be checked. You’ll usually be asked to attend a pre-assessment clinic shortly before your surgery date.
Sometimes this assessment is done once you’re in hospital for your operation. The assessment may involve a number of tests including a chest x-ray, an electrocardiogram (ECG) and blood tests.
You’ll be asked about any medication you're taking. If you smoke, you may be asked to try to cut down or stop smoking to help your recovery from the anaesthetic and surgery.
What should I take with me to hospital?
Your hospital team should provide you with information about your admission and hospital stay as well as what to take with you. We’ve made some suggestions of what to take in our booklet Your operation and recovery.
How long will I be in hospital for?
The length of your hospital stay will depend on what type of surgery you have, how you recover and the support available at home.
Some people who've had breast surgery without reconstruction are discharged from hospital within 23 hours. This means you may have your surgery as a day case or stay overnight, being discharged within 23 hours of admission.
In such cases some people might still have wound drains in place. Your specialist team will talk to you about how long you’ll be in hospital.
For more information about going into hospital, see our booklet Your operation and recovery.
Temporary breast prostheses and post-surgery bras
Find out more about which bras to wear immediately after surgery.
You can also find out more about wearing a temporary breast prosthesis if you’ve not had immediate reconstruction. Find out more about temporary breast prostheses.
Read about reconstructive surgery and what this means for you.