When diagnosed with breast cancer, one of the first topics you, your family and your care team will discuss is your treatment options. For many patients, surgery is the first treatment, followed by chemotherapy or radiation to remove what surgery could not remove.
The main goals of surgery for breast cancer patients are:
- to remove as much of the cancer as possible (breast-conserving surgery or mastectomy)
- to find out whether the cancer has spread to lymph nodes (sentinel lymph node biopsy or axillary lymph node dissection)
- to restore the breast’s shape after cancer has been removed (breast reconstruction)
- to relieve symptoms of breast cancer
The two types of breast cancer surgery to remove the cancer altogether are breast-conserving surgery and a mastectomy.
Breast-conserving surgery, also known as a lumpectomy, is where only the part of the breast containing the tumor is removed. Its goal is to remove the tumor and surrounding tissue, but leave the rest. The amount actually removed depends on the size and location of the tumor. Many women who have early-stage cancers opt for this treatment, as well as those whose cancer is secluded to one spot or whose tumor is less than five centimeters in diameter.
A mastectomy is a surgery where the entire breast is removed, including all breast tissue and sometimes other tissues as well. The two most common types of mastectomies are a simple mastectomy (breast is removed, but lymph nodes and muscle tissues are not) and a double mastectomy (both breasts are removed). A mastectomy might be the best option for you if you have a larger tumor, are pregnant, have the BRCA mutation, or if you have already had breast-conserving surgery and all of the cancer was not removed.
To choose between the two, it is important to talk to your doctors and care team about the stage of your cancer and the risks and benefits of both. The advantage for many for breast-conserving surgery is that you keep your breast, but you will likely also need radiation. With a mastectomy, your entire breast is removed, but you are less likely to also need radiation.
Lymph node surgeries also may be performed to remove your lymph nodes under your arm and determine whether cancer has spread there. This operation can be a part of a surgery to remove breast cancer, or can be separate.
Breast reconstruction surgery is a personal decision if you have a mastectomy and want implants in their place. Some women opt for immediate reconstruction, where they have reconstruction surgery at the time of their mastectomy; others may opt for this at a later time. If you are interested in reconstructive surgery, talk with your breast surgeon and plastic surgeon before your mastectomy so that you can know the plan from the beginning and give the surgical team time to plan your treatment options.