Lumpectomy and Mastectomy to Treat Breast Cancer

The goal of surgery is to remove all cancerous tissue from the breast and any cancer that may have spread to nearby lymph nodes. Our Breast Cancer Program includes a team of surgeons with advanced fellowship training in cancer surgery and breast surgical oncology. They collaborate with other cancer specialists to create the most effective treatment plan for each patient and work cooperatively with plastic surgeons to optimize cosmetic outcomes.

Lumptectomy

Many women with early-stage breast cancer can have breast-conserving therapy (BCT). BCT consists of a lumpectomy (also known as a partial mastectomy or segmental mastectomy) followed by radiation therapy. Extensive research has shown that for carefully selected patients, lumpectomy with radiation therapy is as effective as mastectomy for controlling cancer.

What Happens During a Lumpectomy

During a lumpectomy, the tumor is removed through a small incision in the breast. To help ensure all the cancer is removed, the excision also includes a surrounding margin of normal tissue. Some breast tumors are so small that they cannot be located easily by feel. In these cases, the patient will first have a “preoperative localization” procedure in which a radiologist uses imaging guidance to place a small wire or localized seed at the cancer site. The cancer surgeon uses these as guides for removing the cancerous tissue.

Nearly all people who have a lumpectomy can return home from the hospital on the same day. Radiation treatments typically begins within one month following surgery if chemotherapy is not given. Most women who undergo a lumpectomy are able to return home from the hospital on the same day.

Mastectomy

A mastectomy involves removal of the entire breast. For some women, removal of all or most of the breast is the only way to safely control the cancer. Mastectomy is often required for women with a large tumor, more than one tumor, and those with inflammatory breast cancer. Some women may also choose to undergo mastectomy instead of breast conserving therapy.

There are several kinds of mastectomy. Your surgeon will discuss which option(s) make the most sense for you.

Skin-Sparing Mastectomy

Some patients can have a skin-sparing mastectomy. In this procedure, the breast is removed through an incision around the areola (pigmented portion of the breast). The nipple and areola are removed, and the skin of the breast is left intact. The breast can then be reconstructed with an implant or by using tissue from another part of the body.

Nipple-Sparing Mastectomy

Nipple-sparing mastectomy is an option for certain patients, such as those with early-stage breast cancer or people who choose preventive surgery because they are at high risk for developing breast cancer due to genetic mutations. Important considerations include tumor size and location, if the cancer is near the nipple, blood supply to the nipple (important for healing), breast size, and prior breast surgery. In a nipple-sparing mastectomy, the breast tissue is removed, but the skin, nipple and areola are left intact. 

Breast reconstruction is done at the same time or later. Because the nipple is preserved, the reconstructed breast often looks more natural than with other mastectomy types. The nipple usually loses some or all sensation because nerves must be cut during surgery.

Simple Mastectomy

Simple mastectomy is an option for those who have early-stage cancer or who are at high-risk for breast cancer and do not want reconstruction. Our surgeons ensure that patients undergoing a simple mastectomy have a “flat closure.”

Modified Radical Mastectomy

A modified radical mastectomy involves removing the entire breast and all lymph nodes under the arm (axillary lymph node dissection). It is different than a radical mastectomy because the chest wall muscles are preserved. A modified radical mastectomy is needed for patients with large tumors, those with inflammatory breast cancer, and for some with extensive lymph node involvement. Reconstruction can sometimes be done at the same time as a modified radical mastectomy but is often delayed.

Sentinel Lymph Node Biopsy (SLNB)

When breast cancer begins to spread outside the breast, it tends to spread first to the axillary lymph nodes (the lymph nodes of the armpit). For this reason, these lymph nodes are often removed during breast cancer surgery in a procedure called a sentinel lymph node biopsy (SLNB)

SLNB can be an option for people getting a lumpectomy or mastectomy. It is offered when there is no clinical or imaging evidence that the patient’s cancer has already spread to the lymph nodes. In some select patients, there may be times when SLNB may be safely omitted. Your surgeon will discuss what type of axillary surgery they recommend for you.

To perform a SLNB, a physician injects a radio-labeled tracer substance into the tissue around the tumor or near the areola and this tracer goes to the first few lymph nodes under the arm. During the breast cancer surgery, the sentinel nodes (typically 1-3 nodes) are removed and sent to pathology for analysis.

Axillary Lymph Node Dissection (ALND)

ALND is different from a sentinel lymph node biopsy (SLNB). During ALND, many more lymph nodes are removed (10 to 20) and sent to pathology to see if there are cancer cells within the nodes. Your surgeon may recommend an axillary dissection if cancer is known to be in the lymph nodes, if SLNB shows significant cancer in the lymph nodes or if imaging scans or a physical exam show enlarged or suspicious nodes. The goal of axillary dissection is to help stage the cancer (see how far it has spread) and to keep the cancer from spreading more.

Axillary dissection is done less often than in the past because SLNB often gives enough information to inform the treatment plan, so a complete axillary lymph node dissection may not be needed — but it is still important for certain patients.

Breast Reconstruction After Mastectomy

Extensive research has shown that surgical reconstruction of the breast following mastectomy can help women regain their sense of wholeness. Not every breast cancer patient requires reconstructive plastic surgery, and some choose not to have it. But for women who opt for reconstruction, it is often an important step in their personal recovery. Patients who opt for a lumpectomy (breast conserving therapy) may also choose breast reconstruction if the removal of the tumor and surrounding tissue significantly changes the shape of the breast.

While a mastectomy on only one breast is more common, bilateral mastectomies (removal of both breasts) are performed in many women. Women with the BRCA gene mutation, may opt for a double mastectomy to remove both breasts before any sign of cancer. These patients are also ideal candidates for breast reconstruction. 

Breast Reconstruction Process

Breast reconstruction can start at any time after your mastectomy - immediately following the cancer surgery (before the patient is out of the OR) or 30 years later. Your reconstruction may use your own tissue or implants. 

The Breast Cancer Program includes board-certified plastic surgeons who are specially trained in the latest breast reconstruction techniques. Most commonly, the DIEP flap and SIEA flap are used in breast reconstruction immediately following mastectomy for breast cancer. Increasingly, women who did not have breast reconstruction right after their mastectomies are pursuing delayed breast reconstruction, or reconstruction years after their mastectomies.

The timing and technique will depend on your cancer treatment plan, including the need for chemotherapy or radiation. Your overall health and personal preference also play a role in timing.

Learn More About Breast Reconstruction