Breast Cancer Surgery

Surgery plays a primary role in the diagnosis and treatment of breast cancer. The type of surgery you may have depends on your diagnosis and the surgical options for treatment. At Brigham and Women’s Hospital (BWH), Brigham and Women’s Faulkner Hospital (BWFH) and Dana-Farber/Brigham and Women’s Cancer Center in clinical affiliation with South Shore Hospital, we provide the full spectrum of breast cancer surgical procedures, including radioactive seed localization for breast-conserving surgery, nipple-sparing mastectomy and perforator flap reconstructive therapy.

Read about advances in the surgical management of breast cancer.

Watch this video presentation by Tari A. King, MD, FACS, Chief of Breast Surgery, about advances in breast cancer surgery.

Breast Cancer Surgery Topics

Making Your Breast Cancer Surgery Decision

Receiving a diagnosis of breast cancer is a physically and emotionally difficult situation. It is important, however, to remember that this is not a medical emergency and you have time to learn about your options for care. You will want to take time to talk to your breast surgical care team about the best choice for you depending upon the size and location of your breast cancer, the type and stage, the benefits and risks of each type of surgery and your personal preferences.

We want to ensure that your questions are answered and that you are comfortable with your decisions. We also understand how important your family and loved ones are to comfort and help you through treatment. Whenever possible, we will include them in discussions to keep them as informed as possible.

Options for Breast Cancer Surgery

Mastectomy, or removal of the entire breast, may be medically necessary if the cancer cannot be removed with clear margins. It may also be necessary if cancer exists in multiple areas of the breast. In some cases, choosing mastectomy over lumpectomy may make further radiation treatment unnecessary. Your surgeon will help you understand your options and will work with you and your team to ensure the best possible outcomes for both your health and your appearance.

Breast Conservation Surgery

Lumpectomy, also known as wide excision or partial mastectomy, involves surgical removal of the cancer with a rim of normal tissue. Lumpectomy may be an option when the cancer is localized to one area of the breast. The benefits of lumpectomy include the conservation of the breast and nipple. Studies show that this surgery is as effective in treating cancer as a mastectomy in appropriate candidates. In most cases, radiation treatment is recommended following lumpectomy.

Mastectomy

Total (or simple) mastectomy is a surgical procedure that removes all of the breast tissue. This can be done in a skin-sparing fashion to leave a skin envelope for reconstructive surgery.

Modified radical mastectomy is a surgical procedure that removes the entire breast and the lymph nodes under the arm.

Skin-sparing mastectomy is a technique that preserves as much of the breast skin as possible for reconstruction. It can be performed as a "simple" or "total" mastectomy or as a modified radical mastectomy. During this procedure, the surgeon removes only the skin of the nipple, areola and the original biopsy scar, and then removes the breast tissue through the small opening that has been created. The remaining pouch of skin provides the best form and shape for an implant or a reconstruction using your own tissue. Many women choose this type of mastectomy to achieve the best results from immediate breast reconstruction.

Nipple-sparing mastectomy can be performed in women having prophylactic (preventative) surgery and in selected women with known breast cancer. While mastectomy traditionally involves removing the breast tissue as well as the nipple-areolar complex, in this procedurethe nipple and areola are left intact, with removal of the breast tissue just under the nipple.This may improve the cosmetic appearance of breast reconstruction and may improve patient satisfaction and is felt to be safe for preventing and treating early stage breast cancer.

Lymph Node Surgery

Sentinel lymph node biopsy is a surgical procedure performed to find out if cancer has spread from the breast to the lymph nodes under the arm. It involves injecting a tracer material that helps your surgeon locate the sentinel nodes, the first set of nodes under the arm that drain the breast. Most women have 2-3 sentinel lymph nodes. Your surgeon will remove and examine these nodes to determine if they contain cancer cells. Learn more about sentinel lymph node biopsy.

Axillary lymph node dissectionmay be performed if your doctor has determined that your cancer has spread to the lymph nodes under the arm. It is usually done at the same time as a mastectomy or breast-conserving surgery. Learn more about axillary lymph node dissection.

Lymph node surgery can increase the risk of lymphedema.

Before Breast Cancer Surgery

Before your surgery, you may be scheduled for a visit at the Weiner Center for Preoperative Evaluation or a preoperative phone assessment for preoperative information and tests, as instructed by your doctor.

For more preoperative information, please review the following checklists:

Brigham and Women’s Hospital Preoperative Check List
Brigham and Women’s Faulkner Hospital Preoperative Check List

If your cancer was detected by imaging (mammogram, ultrasound or MRI) your doctor may schedule you for a radioactive seed or wire localization prior to surgery.

Anesthesia for Breast Cancer Surgery

For most breast surgeries, anesthesia can be provided by various techniques. The choices vary with the type of surgical procedure, your medical history and preferences, and the advice of your surgeon and anesthesiologist.

Learn more about anesthetic techniques including regional anesthetic options and how they are usually used. Your surgeon and anesthesiologist can provide more information about each option.

Improving Breast Cancer Surgery Outcomes

Enhanced Recovery After Surgery (ERAS)
The pathway for each surgical procedure has many steps that involve all members of your care team, including you. Part of our pathways build on an approach called Enhanced Recovery After Surgery (ERAS). These are evidence-based guidelines designed to optimize hydration, nutrition and pain control, leading to faster, safer and more comfortable recovery from surgery.

We go beyond ERAS to make sure you are benefitting from the best-known practices during your entire surgical journey, including after you leave the hospital. Our pathways decrease complications, including surgical site infections, heart rhythm problems, blood clots and more. Patients and caregivers alike are seeing the benefits of this team-based approach that revolves around you and your recovery. You and your doctor will discuss the best practices for your surgical procedure.

Systemic Treatment before Surgery
In some cases, you may receive systemic treatment (chemotherapy, hormonal therapy, and/or targeted therapy) for your breast cancer beforeyou have breast surgery. There are important benefits to pre-surgical treatment including:

  • Potential for minimal surgery - If the patient responds to the medication, the tumor will shrink, thereby reducing the amount of surgical intervention needed to treat the cancer.
  • Improved postoperative therapy - Identifying the drugs that are effective in shrinking an individual patient’s tumor may help guide the use of postoperative therapy.

Studies have shown that patients who receive systemic treatment before surgery have the same cure rate as patients who undergo surgery first and then receive systemic treatment afterwards.

Radioactive Seed Localization 
Brigham and Women’s Hospital is among the few hospitals in Massachusetts to offer radioactive seed localization, an innovative, patient-friendly approach for doctors to precisely pinpoint and remove non-palpable breast cancers.

In the past, patients with non-palpable breast tumors were required to undergo breast needle localization a few hours before the biopsy or lumpectomy. The radiologist would insert a needle with a fine wire into the breast to map the location of the cancer, and the wire would remain in the breast, poking out of the skin until surgery.

With radioactive seed localization, a seed containing a very small amount of radioactivity is placed into the breast by the breast imaging specialist up to one week before the surgery. In the operating room, the surgeons use a handheld radiation detection device to locate the seed and precisely navigate to the cancer, which is removed along with the seed during the operation. No radioactivity remains in the body.

Learn more about:

Breast Reconstructive Surgery Following Mastectomy

Our breast cancer surgeons and reconstructive breast surgeons work together to provide patients with options for both immediate breast reconstruction (at the same time as your mastectomy) or delayed breast reconstruction (at a second procedure) based on the characteristics of your cancer, the overall treatment plan and your preference.

Breast reconstruction is achieved through several different plastic surgery techniques that are done to restore the breast mound to near normal shape, size and appearance following a breast cancer diagnosis and mastectomy.

If you having a mastectomy and would like to learn about these options, your surgeon will refer you to one of our specialized breast reconstructive surgeons who will discuss the various options for breast reconstruction and help you decide the best procedure, based on your particular type of breast cancer and expected treatment plan.

Learn more about our reconstructive breast surgery program.

What You Should Expect and Resources

What You Should Expect

You will be cared for by an experienced breast surgical team including surgeons, nurses, anesthesiologists and physician assistants. After surgery, you will recover in the post-surgical care unit where you will receive comprehensive care by an experienced medical and nursing staff. Learn more about your BWH hospital stay and returning home.

Resources

Read blog posts on breast surgery topics on the Brigham and Women’s Hospital HealthHub blog.

Read more information about types of breast cancer at Susan G. Komen.

Access information about types of breast cancer provided by The American Society of Breast Surgeons Foundation.

Visit the Kessler Health Education Library in the Bretholtz Center for Patients and Families to access computers and knowledgeable staff.

Access a complete directory of patient and family services.

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