Breast Cancer Surgery: What’s Right for You?

If you have been diagnosed with breast cancer, your doctor likely will recommend surgery as part of your treatment. That means you will have options to consider.

A range of factors – including the type, size and location of the tumor – will affect the surgical decisions you and your doctor make. The earlier your cancer is identified, the more options you are likely to have.

Breast cancer is treated in two ways. There is a systemic approach that takes into account cancer cells that may have traveled elsewhere in your body. This involves treatments (including chemotherapy and other specialized therapies) taken by mouth or injected into your muscles or bloodstream. A local approach, on the other hand, targets the specific cancer tumor. This is done through radiation therapy and surgery.

Often, the choice of surgeries comes down to what you prefer. It’s not uncommon, for example, for a woman who has been diagnosed with cancer at an early age, or with a higher genetic risk, to choose to have both breasts removed.

Let’s look at three types of breast cancer surgery:

Lumpectomy (Breast-Conservation Surgery)

One of the goals of a lumpectomy is to remove the tumor, while preserving as much of your breast as possible. The procedure is an option for smaller tumors – those smaller than 5 centimeters – that don’t take up over 30 percent of the breast volume.

During the procedure, your surgeon will use advanced imaging to precisely target the tumor to remove it with a margin of healthy tissue surrounding it. That increasea the chances that all the cancer is removed.

In many cases, you will return home the same day as your surgery. You’ll feel tired and have some pain – often handled with over-the-counter medications like ibuprofen or acetaminophen – for a couple days. Heavy lifting will be restricted during the first week, but you will gradually return to normal activities within a few weeks.

Breast conservation surgery is always followed by a course of radiation therapy. Studies have shown that a combination of lumpectomy and radiation therapy gives you a 4 percent chance of cancer recurrence.

Mastectomy Options

A mastectomy is the complete removal of your breast tissue. It may be the only option for more advanced tumors. Some women also opt for the procedure based on personal preferences or elect to have a bilateral mastectomy if they have a higher genetic risk for breast cancer, as was the case with actress Angelina Jolie in 2013.

There are several types of mastectomies, including:

Simple or total mastectomy: The surgeon removes all breast tissue, along with the nipple, areola and some surrounding skin. After the surgery, you have a flat chest wall, with a scar across your chest.

Skin-sparing mastectomy: The surgeon removes the nipple and areola and all the breast tissue, while leaving most of the remaining skin in place. This is always done when reconstruction immediately follows the mastectomy.

Nipple-sparing mastectomy: This is similar to the skin-sparing procedure, except that it also leaves your nipple and areola in place. The incision and resulting scar are usually located under or on the side of the breast. This may not be an option for larger breasts or if the tumor is close to the nipple. This surgery is also always done with reconstruction.

Often, you will go home the same day as your mastectomy, though sometimes a night in the hospital may be needed. There is more pain with a mastectomy, compared with a lumpectomy, but most patients need nothing more than over-the-counter pain medications. There will also be a drain that needs to be emptied twice a day to avoid fluid buildup. Your lifting will be restricted for about a month afterward.

Cancer recurrence rate with a mastectomy is 3 percent, only slightly better than with a lumpectomy.

Mastectomy with Reconstruction

A mastectomy with reconstruction adds a second surgical procedure immediately after the mastectomy. As soon as the initial surgery is completed, your plastic surgeon will step in and perform the first phase of breast reconstruction, inserting a tissue expander under the skin in your chest. Later, another surgery will be done where the expander will be replaced with a permanent breast implant or using your own tissue to reconstruct the breast.  In some cases, the complete reconstruction can be done at the time of the mastectomy.

This mastectomy option can be advantageous if you’d rather not have to deal with delaying the first phase of your reconstruction for several months after your mastectomy. It’s also the preferred choice if you are having a skin-sparing or nipple-sparing mastectomy since the expander takes the place of the removed breast tissue.

Making the Choice

Deciding which option is best is often based on personal preference and how you want to look after the surgery. There is a current trend, for example, of women choosing not to have reconstruction. The decision can also be influenced by the treatment that will follow the mastectomy. Some women choose a mastectomy over a lumpectomy to avoid radiation, which is always required with a lumpectomy and only required in certain patients with a mastectomy.

But it’s important to understand that your choice is likely to have little impact on your risk for a cancer recurrence. Studies have shown that there is no difference in the survival rates in women who choose a mastectomy over a lumpectomy.