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Surgery is mainly used to treat breast cancer. The goal is to remove the cancer, and save as much of the breast and its function. Surgery is often one part of a treatment plan that includes chemotherapy or radiation therapy. Chemotherapy can also be used before surgery to shrink the tumor.

Breast-saving Surgeries

Breast-saving surgeries, often with radiation, are usually used for women in the early stages of cancer. This involves taking out the tumor and a small area of healthy tissue around it. Breast-sparing surgery types include:

  • Lumpectomy
  • Wide excision
  • Segmentectomy
  • Quadrantectomy
  • Partial mastectomy

Lumpectomy
Diagram of lumpectomy

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Not all women with early stages of breast cancer can have these types of surgery. There are certain conditions that keep them from being the best choices such as:

  • Many tumors in more than one part of the breast
  • One tumor has spread throughout the breast
  • The tumor is found under the nipple
  • The tumor is large compared to breast size
  • Health problems such as scleroderma or systemic lupus erythematosus
  • Pregnancy up to 27 weeks—the radiation can harm an unborn baby
  • Prior high-dose radiation to the breast with cancer

Mastectomy

A mastectomy is the removal of the breast. This may or may not involve removing lymph nodes. The type will depend on how much the cancer has spread and if breast reconstruction will be done.

Mastectomy

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Simple Mastectomy

A simple mastectomy is the most common type of surgery. All of the breast is removed. A simple mastectomy may be done for women who:

  • Have ductal carcinoma in situ (DCIS)
  • Have no risk cancer spreading to the lymph nodes
  • Cannot have any type of breast-sparing surgery

Lymph nodes can be taken out and checked for cancer as well. It can be done as part of this surgery or at a later date.

This can be used to prevent breast cancer. One or both breasts can be removed in women who are at a high risk for getting it. It can also be done for women with cancer in one breast and a high risk of cancer in the other.

Skin-sparing Mastectomy

The skin over the breast is spared during a simple mastectomy. This is done for women who will have reconstruction. You and your doctor will decide if this is the best type for you.

A form of this type can spare the nipple and areola. The nipple area will be checked for cancer to see if it can be left behind. Radiation may be given to the nipple during or after surgery. This lowers the risk of cancer coming back. This may not be the best type for all women.

Modified Radical Mastectomy

A modified radical mastectomy is used to treat cancer that has spread beyond the breast. The breast, lining of the chest muscle, with or without the chest wall muscle, are removed. Lymph nodes from under the arm are also removed. Radiation may or may not be needed. It depends on the size of the tumor and if the lymph nodes have cancer.

Radical Mastectomy

A radical mastectomy involves removing the breast, chest wall muscles, lymph nodes under the arm, as well as some fat and skin. This type of surgery is rare.

Other Procedures

Breast cancer surgery can involve more than just removal of the tumor and breast tissue. The lymph nodes are often removed and tested for cancer. This can help find if cancer has spread. The types are:

  • Sentinel node biopsy —A sentinel node is the first lymph node that a tumor drains into. Other nodes are checked until the they are clear from cancer.
  • Axillary node dissection —Many lymph nodes from the underarm are removed and checked for cancer. It may be done at the same time as breast surgery or at a later date.

This can lead to lymphedema. Lymph vessels are found all over the body, but may become blocked when lymph nodes are removed. This can cause a backup of fluid into tissue. Your care team will teach you how to control lymphedema.

Breast Reconstruction

Reconstruction can be done with a mastectomy, at a later date, or not at all. Your doctor will help you find what works best for you.

If you decide to do this, talk with a plastic surgeon before surgery. Tell the doctor if you need radiation or there is cancer in the lymph nodes. You may have to wait between the radiation and reconstruction.

REFERENCES:

Breast cancer. Merck Manual Professional Version website. Available at: https://www.merckmanuals.com/professional/gynecology-and-obstetrics/breast-disorders/breast-cancer. Updated January 2018. Accessed March 11, 2019.

Breast cancer in women. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T113654/Breast-cancer-in-women. Updated November 26, 2018. Accessed March 11, 2019.

Surgery for breast cancer. American Cancer Society website. Available at: https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer.html. Updated August 18, 2016. Accessed March 11, 2019.

Surgery for early and locally advanced breast cancer. EBSCO DynaMed Plus website. Available at:http://www.dynamed.com/topics/dmp~AN~T901192/Surgery-for-early-and-locally-advanced-breast-cancer. Updated January 24, 2018. Accessed March 11, 2019.

Treatment option overview. National Cancer Institute website. Available at: https://www.cancer.gov/types/breast/patient/breast-treatment-pdq#section/_185. Updated February 6, 2019. Accessed March 11, 2019.

Last reviewed December 2018 by EBSCO Medical Review Board Mohei Abouzied, MD, FACP  Last Updated: 3/11/2019