Breast Cancer Surgery

Surgery is a central part of treatment for most breast cancers, and its goal is to remove the cancer completely while keeping as much healthy tissue and normal appearance as possible. There are two main approaches to removing the tumor.

Breast-conserving surgery, also called a lumpectomy, removes the cancer along with a rim of surrounding normal tissue while preserving the rest of the breast, and it is usually followed by radiation therapy.

A mastectomy removes the entire breast and may be recommended when a tumor is large, when there are several areas of cancer, or according to a person's own preference and risk.

Surgery also allows the lymph nodes under the arm to be checked, which is one of the most important ways to learn whether the cancer has begun to spread.

Before surgery, several tests are usually arranged, which may include blood tests, imaging, and an assessment of fitness for anesthesia. Certain medications, especially blood thinners, may need to be adjusted, and fasting is required for a set period before the operation. When a tumor cannot be felt, a thin wire or a small marker may be placed using imaging beforehand to guide the surgeon to the exact location. This is also the time to discuss reconstruction options if a mastectomy is planned.

The operation is performed under general anesthesia, meaning the person is asleep throughout. In breast-conserving surgery, only the tumor and a margin of healthy tissue are removed, preserving the breast. In a mastectomy, the whole breast is removed, and reconstruction may be carried out at the same time. To assess the lymph nodes, surgeons often perform a sentinel lymph node biopsy, in which a dye or a tracer is used to identify and remove the first one or two nodes that drain the breast; if these contain cancer, more nodes may be removed. 

As with any operation, there are some risks, including bleeding, infection, and a reaction to anesthesia. Specific to breast surgery, a collection of fluid called a seroma may form at the site, and there may be temporary or lasting numbness near the scar. When underarm lymph nodes are removed, there is a risk of lymphedema, which is long-term swelling of the arm. Occasionally, if the removed tissue does not have a clear margin, a further operation is needed to remove additional tissue.

After surgery, the removed tissue is examined in detail, and this pathology report confirms the type and extent of the cancer and whether the lymph nodes are involved. These findings guide any further treatment, such as radiation, chemotherapy, hormone therapy, or targeted therapy. Recovery is supported with guidance on wound care, arm exercises, and gradual return to activity, and long-term follow-up includes monitoring for recurrence and for lymphedema. For those who have had a mastectomy, reconstruction can restore the shape of the breast.

FREQUENTLY ASKED QUESTIONS

Is a mastectomy safer than breast-conserving surgery?

• For many people who are suitable for it, breast-conserving surgery followed by radiation gives results comparable to mastectomy. The best option depends on the individual cancer, and your surgeon will explain which approaches are appropriate for you.

Will all of my lymph nodes be removed?

• Usually not. Surgeons often begin with a sentinel lymph node biopsy, which removes only the first one or two nodes that drain the breast, and more extensive removal is done only if needed. This helps reduce the risk of complications such as lymphedema.