Breast Surgery Information

The type of surgery recommended depends on the area of the breast affected, the size of the cancer relative to the size of your breast and whether more than one area in the breast is affected. Your breast surgeon will discuss this with you. There are two main types of breast cancer surgery:

1. Breast-conserving surgery
You might also hear this called a ‘lumpectomy’ or ‘wide local excision’. Breast-conserving surgery is when surgeons take out the cancer and an area of healthy breast from all around it. The healthy part is called a margin or a border.
Breast-conserving surgery tries to keep as much of your breast as possible while taking out all the cancer.
If you have breast-conserving surgery, it’s important that a clear margin of tissue is taken from around the cancer. If a clear margin of tissue is not seen when the area removed is examined under the microscope, sometimes a second operation is needed.
If you are having breast-conserving surgery, you will usually have radiotherapy on the remaining breast tissue on that side.

2. Mastectomy
A mastectomy is when all of your breast is taken away often including the nipple area.

The treatment team usually suggests a mastectomy when:
• The cancer takes up a large part of the breast.
• There is more than one area of cancer in the breast.
Some people ask for a mastectomy even when it has not been suggested by the treatment team. If you are having a mastectomy, your surgeon will talk with you about choosing whether or not to have breast reconstruction surgery. If you’re going to have a mastectomy, you’ll usually be able to have breast reconstruction either at the same time as your mastectomy (immediate reconstruction) or at a later date (delayed reconstruction).

For more details, please see Breast Reconstruction

Margins
It’s important that the cancer is removed with an area (margin) of healthy breast tissue around it to make sure no cancer cells have been left behind.

The breast tissue removed during surgery will be tested to check the margin around the cancer:
• Negative (clear) margins mean no cancer cells were seen at the outer edge of the tissue removed.
• Positive margins mean the cancer cells are very close to or reach the edge of the tissue.
If you have negative or clear margins, it’s unlikely you’ll need more surgery to the breast.
If there are cancer cells at the edges of the margin, you may need further surgery to remove more tissue. Some people may need a mastectomy to ensure all the cancer has been removed.

If you need a mastectomy, your treatment team will talk with you about:
• Whether you want a breast reconstruction
• What sort of breast reconstruction would work best for you
• When you might have breast reconstruction.
Your breast care nurse will be able to show you photographs of different types of breast reconstruction and go through all options in details with you.

If you’re offered a choice
Some people will be offered a choice between breast-conserving surgery and a mastectomy.
Long-term survival is the same for breast-conserving surgery followed by radiotherapy as for mastectomy.
Studies show that women who have a wide local excision may be slightly more likely to have a local recurrence (where breast cancer returns in the same breast), which can be treated again. However, most people don’t have a recurrence.

Talk to someone
You may find it helpful to talk through your choices with your breast care nurse.

Questions you might want to ask your specialist team about your surgery include:
• What surgery will I need and why?
• Where will the scars be?
• What will my breast area look like after surgery?
• What side effects can I expect?
• How long will I take to recover?
• Can I see photographs of people who have had breast surgery?
• Can I see some breast prostheses (artificial breast forms)?

What is lymph node surgery?
Lymph node surgery is an operation to take away glands from under your arms. The glands are called lymph nodes. Breasts contain a network of tiny tubes called lymph vessels. These are connected to the lymph nodes (glands) under the arm. Lymph nodes are arranged in three levels, and the exact number of nodes in each level varies from person to person. Breast cancer cells can sometimes spread to the lymph nodes under the arm. Anyone with invasive breast cancer will have the lymph nodes under the arm assessed. The outcome of this will help the specialist team recommend which treatments are best for you.
Your surgeon is likely to recommend an operation to remove either some (a lymph node sample or biopsy) or all of the lymph nodes (a lymph node clearance).

For further details, see Lymph node surgery

What are the side effects of surgery?
There are lots of possible side effects from breast cancer surgery.
You probably won’t have them all. A lot of the side effects only last for a short while after you have had your operation. For example, feeling or being sick. Some side effects might last a bit longer.

These include the list below:
• Pain
• Bruising and swelling
• Changes in feelings in your breast area or down your arm on the side where you have your operation
• Stiff shoulder

A few side effects from breast cancer surgery can stay with you for good.
These include:
• Scars.
• A swelling of your arm, hand or breast area that can happen weeks, months or even years after your surgery. This swelling is called lymphoedema.
Always tell your breast care nurse or treatment team how your treatment is affecting you. They can often suggest things to help make side effects easier to cope with.

back to the top of the page