Just the word surgery is enough to make you want to pull the covers over your head and go back to sleep. We know. But really, it’s a good thing: Breast cancer surgery will remove the tumor and put you on the fast-track to better health. That doesn’t necessarily make it less scary-sounding, which is why we’re breaking it down into manageable pieces so you can feel confident that you know what’s happening every step of the way.
Just the facts: If you have breast cancer, you’ll probably need to have surgery to remove the cancer cells. You might also need to have one or more lymph nodes removed to see if cancer cells have spread beyond your breast.
Your doctor will talk with you about two main surgical options. Which one you opt for depends on the size and stage of the cancer. Here's what you're likely looking at:
- Lumpectomy: This procedure removes the tumor and a small amount of surrounding tissue. It usually requires radiation treatment afterward.
- Mastectomy: This operation removes all the breast tissue. Many women also have reconstructive plastic surgery to rebuild their breasts.
A lumpectomy plus radiation and a mastectomy have similar cure rates, so women are often able to choose which option is best for them based on tumor size, recovery time, how they want to look afterward, and personal preferences. Your surgeon should talk with you about the risks and benefits of all options, but ultimately, the choice is yours.
After a surgeon performs the operation, you’ll work with a medical oncologist to figure out if further treatments such as radiation, hormonal medications, immunotherapy, or chemotherapy are necessary to help kill remaining cancer cells and prevent the tumor from growing back.
Let's dive a little deeper into some of the pros, cons, risks, recovery, and possible side effects to consider when it comes to breast cancer surgery.
What Is a Lumpectomy?
Lumpectomy, sometimes called breast-conserving surgery or partial mastectomy, is a procedure where only the part of the breast with cancer is removed. (Some surrounding tissue may also be removed to make sure the surgeon gets all of the cancer.) The amount of breast tissue that needs to be removed will vary based on how big the tumor is and where it’s located.
What to expect
This is not your mother’s lumpectomy: The procedure has become increasingly sophisticated over the last couple of decades. It used to be that surgeons would make an incision over the tumor then just scoop it out—effective, but not exactly attractive in its final result. Today, breast surgeons often use strategically placed incisions that produce less-visible scars and even move remaining breast tissue around a bit to help the breast keep its shape. If a lot of tissue needs to be removed, some surgeons may be able to remove tissue from your other breast to keep them symmetrical.
Some more details about what lumpectomy surgery is like:
- Procedure: The operation is fairly quick—it usually takes between 15 and 40 minutes. Your surgeon may also remove a few nearby lymph nodes—called sentinel nodes—to check and see if the cancer cells have spread. (And don’t panic: If it has spread to your lymph nodes it does not mean it’s traveled elsewhere in your body.) A lumpectomy is usually an outpatient procedure, and you can go home from the hospital the same day.
- Recovery: Every woman heals differently, but it’s likely that you can return to work a few days to a week after surgery. (You’ll heal a little quicker if you haven’t had any lymph nodes removed.) It’s totally normal to feel soreness, numbness, and tickling sensations in the area for a few months after surgery.
- Radiation after lumpectomy: It’s likely that if you have a lumpectomy you will also need radiation—high-energy rays delivered directly to breast—a few weeks after surgery. Typically, radiation therapy is given five days per week for up to five to six weeks. Many patients who have no involvement of lymph nodes receive a three to four week course. Rapid one week courses may be effective, but don’t have very long follow-up results. Each radiation treatment lasts minutes, and paths are usually in the department for about 15 minutes.
- Side effects: Radiation commonly causes side effects like sensitive skin, fatigue, reddened skin that may peel (like a sunburn), and swelling that can last for a few months. There are other potential side effects, too, including a decrease in milk production if you are breastfeeding, swelling in the arm or chest (called lymphedema), or nerve damage.
What Is a Mastectomy?
In a mastectomy, all of the tissue in your breast is removed. There are a few reasons a surgeon may recommend a mastectomy instead of lumpectomy, including cases where the breast has several separate areas of cancer, or if the tumor is large relative to the overall breast size, or if you have inflammatory breast cancer or another aggressive type.
There are also several different kinds of mastectomy surgery. If you go this route, the kind you’ll get will depends on how large the tumor is, if there are multiple tumors, and where the cancer is located in your breast. Your surgeon might also remove nearby lymph nodes to see if cancer cells have spread.
The three most common types of mastectomy surgery are:
- Simple mastectomy (or “total mastectomy”). In this operation, your whole breast is removed, including the nipple, areola, and most of the skin. If the cancer has spread to lymph nodes under your arms, those will need to be removed, too. In that case, the surgery is called a “modified radical mastectomy.”
- Skin-sparing mastectomy. In this procedure, the surgeon removes all of the breast tissue, nipple, and areola, but leaves the original envelope of skin ready to be reconstructed with a breast implant or other plastic surgery procedure.
- Nipple-sparing mastectomy. In some cases, it’s safe for a surgeon to leave a woman’s nipple and areola intact. The nerves, ducts, and tissues that attach to them will be gone, however, so your nipple will likely be numb and will no longer function as it did.
What to Expect
The exact procedure differs based on what type of mastectomy you need. That said, here are some basics for what to expect.
- Procedure: Surgery typically takes up one to three hours, and it requires one to three days in the hospital. Before closing you up, your surgeon will insert thin tubes to help drain fluid as your incisions heal.
- Recovery: The drain tubes are usually removed after a couple of weeks, which is good since you won’t be able to drive or lift your arms above your head until they’re taken out. Full recovery typically takes two to three weeks, although some people go back to work before that.
- Follow-up treatment: After your mastectomy, you may need to receive additional treatment such as hormonal medications, chemotherapy, radiation, or other targeted medications.
Choosing Between a Lumpectomy and Mastectomy
For appropriately selected patients, the long-term survival chances are the same when comparing mastectomy and lumpectomy. If you choose a lumpectomy, you’re in the majority: Lumpectomy plus radiation is an option for between 70 and 90 percent of women with early-stage cancer. Because it is a simpler surgery than a mastectomy, with quicker recovery and less chance for complications, many breast surgeons prefer a lumpectomy for women who are candidates for it.
On the other hand, there are pros and cons to both types of breast cancer surgeries. A 2015 study in JAMA Surgery found that about one-third of women with early-stage breast cancer who are candidates for a lumpectomy still opt for full breast removal. These are some things to consider:
Lumpectomy: Pros and Cons
Pros: A lumpectomy is a more minor surgery than a mastectomy, requires no hospital stay, has a smaller chance of complications, and is quicker to recover from. Women generally report having a better body image after a lumpectomy than a mastectomy—even among those who have reconstructive plastic surgery after breast removal.
Cons: Although survival rates of women who have a lumpectomy versus a mastectomy are the same, breast cancer recurs more often in those with the less-aggressive surgery. It’s usually treatable with additional surgery, which is why survival rates are the same. About 20% of women will need additional surgery after having a lumpectomy. Most will have another lumpectomy to remove more cancer cells; a very small percentage go on to have a mastectomy and remove all the breast tissue.
Mastectomy: Pros and Cons
Pros: After a mastectomy, women typically no longer need regular mammograms. The chances of breast cancer recurring are generally low; and it’s slightly less likely that that breast cancer will recur if a woman has a mastectomy versus a lumpectomy. Women who are anxious about a recurrence may feel more at ease having all their breast tissue removed and knowing their chances of having to deal with breast cancer again are bit lower.
Cons: There is a higher chance of post-surgical complications such as swelling in the arms and limited range of motion, and women who do not have reconstruction will have to adjust to what it looks and feels like to no longer have a breast and/or using a prosthetic breast. More than half of women who have mastectomies go on to have reconstructive plastic surgery which can have very good aesthetic outcomes. On the other hand, reconstruction includes more surgery, pain, recovery time, and risk of complications.
Some women may also opt to have a double mastectomy, removing the other breast even if it does not show signs of cancer. This decision is often based on family history of breast cancer and genetic predisposition to the disease. Clearly, the choice is complex and very personal—and there’s no one “right” choice for a woman with breast cancer.
Breast Cancer Surgery Side Effects
If you have breast cancer surgery, it’s possible that you will experience temporary side effects like pain and swelling that go away once you are healed. Sometimes, the surgery results in longer-lasting—even lifelong—changes, such as loss of sensation in the skin or nipple or a type of swelling called lymphedema. Lymphedema typically happens in the arm, breast, torso, or hand on the side of the body where you had surgery. Mild lymphedema can often be reversed, but sometimes it comes and goes and needs to be managed with treatments like pressure sleeves, pumps, bandages, and lifestyle changes. Lymphedema can also cause tingling, achiness, and general discomfort. It’s considered an uncommon side effect, however—estimates show that only 5 to 25% of women will experience it after breast cancer surgery.
Whatever route you go, it’s going to be a little nerve-wracking. Take some solace in knowing that 268,600 cases of invasive breast cancer were diagnosed in the U.S. in 2019 alone—that’s a lot of surgeries performed. For better or worse, it’s a common procedure with well-known risks and side-effects, but it also comes with a proven track record for getting rid of your breast cancer for good.