Breast Cancer Surgery

Breast surgery is the most common form of treatment for people who are diagnosed with early (stage 1 and 2) or locally advanced (stage 3) breast cancer. There are two main types of surgery commonly used to treat breast cancer, breast conserving surgery or mastectomy.

Types of breast cancer surgery

The objective of breast cancer surgery is generally to remove a tumour from the body. Below are the most common types of breast cancer surgery:

Lumpectomy (breast conserving surgery)

A lumpectomy is surgery to remove the breast cancer and small amounts of breast tissue. This is also known as breast conserving surgery, complete local excision, wide local excision or partial mastectomy. The tumour and some additional non-cancerous tissue surrounding it will be removed to make sure that no traces of the tumour remain in the body.

Some women may also have lymph nodes removed from their underarm. The tumour and lymph nodes will often then be examined closely to determine whether or not further treatment will be required. Most women who receive a lumpectomy are also advised to have radiotherapy.

Mastectomy (full breast removal surgery)

A mastectomy is the removal of the entire breast and usually removal of lymph nodes. There are different reasons that a mastectomy may be recommended, some of which include:

• If there is cancer in more than one area of the breast
• If the tumour is large in comparison to the breast itsel
• If the patient carries a gene mutation (such as BRCA1/2) that could pose an increased risk of developing breast

A mastectomy may also be recommended after breast conserving surgery:

• If previous radiation therapy has taken place in the same breast and the cancer has returned
• If breast cancer comes back in the same breast
• If cancer cells appear in the surgical margin surrounding the tumour that was previously removed.

A prophylactic (preventative) mastectomy:

Some women may choose to have a double mastectomy, where both breasts are removed. In rare cases, women who do not have breast cancer may choose to have a double mastectomy. This is called prophylactic mastectomy, also known as a preventative mastectomy.

This may be an option for those who have a strong family history of breast cancer, or those who have undertaken genomic testing which indicates a higher risk of developing breast cancer. Women who have a mastectomy may opt to have breast reconstruction surgery at the same time, or this can take place later in a separate procedure.

What does breast cancer surgery involve?

Breast cancer surgery will involve an incision in the breast to remove the cancer and surrounding tissue. The amount of breast tissue removed will depend on whether it is a breast conserving surgery to remove part of the breast tissue or a mastectomy to remove one or both breasts. The Incision is then with stitches (sutures), which will either dissolve or be removed later.

In many cases, breast cancer surgery will also involve the removal of one or more lymph nodes from the underarm area.  A mastectomy usually takes one to two hours, while breast conserving surgery usually takes up to one and a half hours. Both types of breast surgery are performed under general anaesthetic, meaning that patients are unconscious throughout the procedure.

Recovering after breast cancer surgery

After breast cancer surgery, the wounds and surrounding tissues need time to heal. The length of the recovery process will depend on the procedure that took place, as well as how well the patient is recovering. Patients undergoing breast surgery could be in hospital for one day or one week, depending on the individual.

Side effects of breast cancer surgery

Everyone responds differently to the side effects that are experienced after a breast surgery and these may vary in severity. The side effects may happen straight after surgery or develop over time. Some of these may include:

• Pain, discomfort or numbness in the breast area and/or underarm while the wounds are healing – this usually settles after a few weeks
• Stiffness in the arm or shoulder – it may be helpful to do some approved exercises after surgery
• Numbness or tingling in the arm or shoulder if lymph nodes have been removed – this may improve with time, but feeling in these areas may change permanently
• Fluid may collect in or around the scar in the breast area or underarm – this is called a seroma and may need to be drained using a fine needle and a syringe; this can be done by a breast care nurse or another health professional in the clinic or by a GP
• Mild pain in the arm and/or underarm – this can last a year or more after surgery if lymph nodes have been removed.
• If lymph nodes have been removed, there may be swelling in the arm, breast area, hand or chest that lasts after the initial side effects of surgery are over; this is called lymphoedema and can develop a few months or years after .
• Cording, a condition that can feel like a tight cord running from the underarm down the inner arm

Breast Reconstruction Surgery

After a mastectomy, some women will consider having a breast reconstruction. This is surgery to rebuild the breast shape and will involve the surgical insertion of a breast implant or the transfer of skin, tissue and muscle from another part of the body to the chest. The latter is known as a tissue flap breast reconstruction.

Whether or not to have a breast reconstruction is a personal choice, and not necessarily for everyone. Women may have the choice between having a breast reconstruction at the same time as a mastectomy or at some point later. Some women will also decide not to have a breast reconstruction and/or use an external prosthesis to create the shape of the breast.

Frequently Asked Questions About Breast Cancer Surgery