By Dr. Mandy Greenberg, Breast Surgery, Nuvance Health
Surgery is the most common form of treatment for breast cancer. The goal of surgery is to remove the cancer and leave cancer-free margins (normal tissue) around where the tumor was. Surgery may also include removing lymph nodes.
There are different kinds of breast cancer surgery depending on the size, location and type of cancer. In addition, other variables determine the kind of surgery recommended, including someone’s age, breast size and personal preference.
What are the types of breast cancer surgery?
A breast surgeon removes the cancerous tumor and surrounding normal tissue from the breast during a lumpectomy. A lumpectomy is a breast conservation surgery and sometimes called a partial mastectomy. The surgeon preserves as much of the breast as possible, allowing for a better cosmetic result.
Mastectomy involves removing the entire breast. A breast surgeon may recommend mastectomy if a patient has a larger cancer not amenable to lumpectomy, multiple sites of cancer or a high risk of future breast cancer. For example, patients with genetic mutations such as BRCA1 or BRCA2 may have up to a 60 percent risk of additional breast cancers in the future.
What breast reconstruction options are available after a mastectomy?
Most women opt for mastectomy with reconstruction. The type of reconstruction depends on breast size and personal preference.
The most common type of reconstruction uses an implant to replace the breast and is typically performed at the same time as the mastectomy. Most patients require a staged procedure where a tissue expander is placed at the time of mastectomy and later exchanged for a silicone or saline implant at a later date.
What is oncoplastic surgery?
The most important goal of surgery for breast cancer is to remove the cancer and achieve clear margins. But how the breast looks after surgery is also important. There are more options now for achieving cosmetically appealing outcomes using techniques called oncoplastic surgery. Oncoplastic surgery combines the techniques of traditional breast cancer surgery with the cosmetic advantages of plastic surgery. Learn more about oncoplastic surgery.
With oncoplastic surgery, we aim to make small incisions and hide scars if possible — usually along a skin fold or around the edge of the areola.
Nipple-sparing mastectomies are widely accepted, which is different from traditional breast reconstruction. For women who do not have extensive cancer or nipple involvement, surgeons can preserve the nipple-areolar complex. This allows for better scar placement and offers excellent cosmetic results, making it a game changer for women who have to undergo mastectomy.
How do breast surgeons decide what type of surgery is best for a patient?
We follow evidence-based guidelines for surgery and make recommendations in conjunction with a patient’s full care team, including medical oncology and radiation oncology. Genetic testing plays an important role in determining how likely it is that the patient will develop additional breast cancers in the future, which may influence a patient’s decision. Most women are candidates for breast conservation surgery (lumpectomy or partial mastectomy) with great cosmetic outcomes using traditional as well as oncoplastic techniques.
The bottom line: Advances in surgical options for breast cancer have resulted in more targeted and less invasive interventions, leading to better outcomes and more options for reconstruction. For example, we are able to spare more healthy tissue by using markers to precisely identify the tumor. In some cases, we can also remove fewer lymph nodes, which can help prevent side effects such as lymphedema.