Essential Facts About Breast Cancer Surgery

Essential Facts About Breast Cancer Surgery

Here's what you should know before choosing a surgery—your options may surprise you.

Surgery is the number one treatment for breast cancer today. That’s because surgeons have found ways to make operations safer, more successful and less invasive over recent years. 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. However, having to make a decision—while you may already be emotionally or physically exhausted—can feel overwhelming. We spoke with Mark Mugiishi, MD 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, a practicing general 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.

If a concerning area shows up on a mammogram or an ultrasound, surgeons use a needle to take a sample of the spot, and 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 or a change on your mammogram 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.

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 and some people may get back to their normal routine in as little as one to two days,” he says.

Most people who undergo BCS also need radiation, or a type of therapy that uses powerful rays, like an X-ray, to destroy leftover cancer cells. Radiation typically has mild side effects like exhaustion, skin changes and breast swelling.

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 an overnight in the hospital 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

“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. There are different types of breast reconstruction, so talk to a plastic surgeon about the best approach for you. 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.

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

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—you may be anxious to remove the cancer as quickly as possible. But take the time to:

  • Research your options. A good place to start? 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.

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.

Read more from Dr. Mugiishi.