Essential Facts About Breast Cancer Surgery
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Essential Facts About Breast Cancer Surgery

Choosing a treatment plan is highly personal, but your options may surprise you.

Surgery is one of the most common treatments for breast cancer. In recent years, surgeons have found ways to make operations safer, more successful and less invasive. Medical advances mean people with breast cancer can now choose from different surgeries, such as:

  • Breast conserving surgery
  • Mastectomy
  • Mastectomy with breast reconstruction

These options can let you build a treatment plan around your priorities and lifestyle, as well as the severity of your diagnosis. However, having to make a decision at a time when you may already be emotionally or physically exhausted can feel overwhelming. We spoke with Mark Mugiishi, MD, a surgeon who specializes in breast surgery at Ekahi Health/Central Medical Clinic in Honolulu, Hawaii and Chief Medical Officer of the Hawaii Medical Service Association, to bring you clear, straightforward answers about what each procedure entails and help you feel confident about your final decision.

Surgery to diagnose breast cancer
“Surgery is used to both diagnose and treat breast cancer,” says Dr. Mugiishi. If a concerning area shows up on a mammogram or an ultrasound, surgeons use a needle to take a sample of the spot. They will then look at it under a microscope to make a diagnosis, explains Dr. Mugiishi.

This procedure, called a biopsy, is the only way your surgeon can confirm that a painful lump, a spot on your mammogram or a change in your breast is cancer.

Surgery to remove cancer
You and your doctor may discuss a number of possible surgeries, depending on your diagnosis and personal preferences. For most people, choices include:

Breast conserving surgery (BCS): The goal of BCS is to remove the tumor, plus some of the healthy tissue around it, called the margin. The margin is then tested to determine if the entire tumor has been removed or if cancer cells may have been left behind. The amount of breast tissue removed depends upon the size of the lump, its location and the advancement of cancer, among other factors.

Whenever possible, surgeons try to do BCS—as long as everything around the tumor is healthy tissue—because it preserves the breast, explains Mugiishi.

The recovery time for BCS is also shortest. It can be done as an outpatient procedure, meaning you won’t have to spend the night in the hospital. “Afterwards, you’ll be able to resume activities when you see fit,” he says, although it may take some women as much as two weeks.

Most people who undergo BCS also need radiation, a type of therapy that uses powerful rays to destroy leftover cancer cells. Radiation is a local treatment, aimed at only the part of your breast that has been affected by cancer. Every person reacts differently, but it may cause side effects like exhaustion and skin irritation. Radiation may also cause long-term changes to the size, coloration, pores, sensitivity and thickness of breasts.

Mastectomy: A mastectomy involves removing the entire breast. Depending on how far the cancer has spread, some of the structures around it, like chest muscles and lymph nodes, might be taken out too. This surgery may require a hospital stay, and it may be a few weeks before you’re back to your old routine.

You might undergo a mastectomy instead of BCS if:

  • Your tumor is large or there’s not a clear margin around it
  • You have multiple tumors
  • You don’t want or can’t have radiation
  • You’ve already had BCS in that breast, but the cancer came back
  • You have the BRCA1 or BRCA2 gene
  • You’re at a high risk for a second cancer

Ultimately, the choice between BCS and a mastectomy is highly person. “The cure rates for BCS and mastectomy are identical,” says Mugiishi. But, since you keep your breast with BCS, there’s a tiny chance that cancer will come back in that area. If it does, you may need a mastectomy at that point, he adds.

Mastectomy with reconstruction: You may choose to have breast reconstruction done along with your mastectomy. This surgery will rebuild the shape and function of the breast after a mastectomy or invasive BCS procedure. Even if you wait a while before undergoing reconstruction, it’s still important to speak with both a general surgeon and a plastic surgeon before your mastectomy. There are different types of breast reconstruction, so they can help you decide the best approach for you

If you’re going to have reconstructive surgery in the future, you might even get the plastic surgeon who’s going to be involved in the initial [mastectomy] operation,” says Mugiishi. “They can align the scars exactly the way they would for reconstruction.”

Checking for the spread of cancer
Your surgeon will most likely perform a sentinel node biopsy during breast cancer removal surgery. Lymph nodes are tiny glands that collect waste, germs and cancer cells, and then filter them out of the body. When cancer spreads, it tends to reach certain lymph nodes, or “sentinel nodes” first. A sentinel node biopsy involves removing the lymph node or nodes (usually one to three) that filter and drain the breast tumor area, and then checking them for cancer.

“If the sentinel node doesn't have cancer in it, then there's no need to remove any more,” says Mugiishi. If cancer has reached the first lymph node, your surgeon may need to take additional nodes from your armpit area to determine how far the cancer has spread.

Choosing the surgery that’s right for you
When trying to decide on a surgery, you might feel a sense of urgency about removing the cancer as quickly as possible. But take the time to:

  • Research your options. Ask your nurse for handouts on each procedure. As you read, make a list of questions for your surgeon, and then take notes while talking to them.
  • Involve a plastic surgeon.
  • Discuss your treatment plan with loved ones.
  • Find out your family history, including if any loved ones have had cancer

Whenever possible, get a second opinion, as well. This won’t insult your surgeon—they’ll want you to feel secure in your final decision. Gathering as much information as possible can set your mind at ease and put you in control of your treatment plan.