Surgery to remove breast cancer

There are two main types of surgery to remove breast cancer:

• Breast-conserving surgery is surgery to remove the cancer as well as some surrounding normal tissue. Only the part of the breast containing the cancer is removed. How much breast is removed depends on where and how big the tumor is, as well as other factors. This surgery is also called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy.

• Mastectomy is a surgery in which the entire breast is removed, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomies. Some women may also have both breasts removed in a double mastectomy.

Choosing between breast-conserving surgery and mastectomy

Many women with early-stage cancers can choose between having breast-conserving surgery (BCS) and mastectomy. The main advantage of BCS is that a woman keeps most of her breast. But most often, she will also need radiation. Women who have mastectomy for early-stage cancers are less likely to need radiation.

For some women, mastectomy may be a better option or the only option, because of the type of breast cancer, the large size of the tumor, previous treatment with radiation, or certain other factors.

Some women might worry that having a less extensive surgery might raise the risk of the cancer coming back. But studies of thousands of women over more than 20 years show that when BCS is done with radiation, survival is the same as having a mastectomy, in people with early-stage cancer who are candidates for both types of surgery.

Surgery to remove nearby lymph nodes

To find out if the breast cancer has spread to underarm (axillary) lymph nodes, one or more of these lymph nodes will be removed and looked at in the lab. This is important to figuring out the stage (how big and where it has spread) of the cancer. Lymph nodes may be removed either as part of the surgery to remove the breast cancer or as a separate operation.

The two main types of surgery to remove lymph nodes are:

• Sentinel lymph node biopsy (SLNB) is a procedure in which the surgeon injects a dye and then removes only the lymph node(s) under the arm that have taken up the dye. These lymph nodes are where the cancer would likely spread first. Removing only one or a few lymph nodes lowers the risk of side effects that can happen after an axillary lymph node dissection (below), such as arm swelling that is also known as lymphedema.

• Axillary lymph node dissection (ALND) is a procedure that does not use a dye and in which the surgeon removes many (usually less than 20) underarm lymph nodes. ALND is not done as often as it was in the past, but it might still be the best way to look at the lymph nodes in some situations.

To learn more about these procedures, see Lymph Node Surgery for Breast Cancer. 

Wire localization to guide surgery

Sometimes, if the cancer in your breast can’t be felt, is hard to find, and/or is difficult to get to, the surgeon might use a mammogram or ultrasound to guide a wire to the right spot. This is called wire localizationor needle localization. If a mammogram is used you may hear the term stereotactic wire localization. Rarely, an MRI might be used if using the mammogram or ultrasound is not successful.  

After medicine is injected into your breast to numb the area, a mammogram or ultrasound is used to guide a thin hollow needle to the abnormal area. Once the tip of the needle is in the right spot, a thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place. The needle is then taken out. Once in the operating room, the surgeon uses the wire as a guide to find the part of the breast to be removed.

The surgery done as part of the wire localization may be enough to count as breast-conserving surgery if all of the cancer is taken out and the margins are negative. If cancer cells are found at or near the edge of the removed tissue (also called a positive or close margin), more surgery may be needed.  

It should be noted that a wire-localization procedure is sometimes used to perform a surgical biopsy of a suspicious area in the breast to find out if it is cancer or not. 

There are other ways a surgeon can be guided to the tumor, but these techniques are newer and not used in every facility.