Surgery for Breast Cancer Treatment

Surgery is used to remove the cancer from the breast. During surgery, some lymph nodes under the arm are also removed. These lymph nodes are examined under a microscope to see if there are cancer cells present. This is very important to determine the stage of the cancer and guide further treatment decisions.

Multiple types of surgery can be used for breast cancer including:

Breast-conserving surgery

This can be called by multiple other names including lumpectomy, segmental mastectomy, partial mastectomy and wide excision. The cancer is removed from the breast with a small amount of surrounding normal tissue and the breast is left intact. This is usually followed by radiation therapy to the remaining breast or in some cases to just the portion of the breast surrounding the surgical site.

Mastectomy

  • Simple or total mastectomy removes the entire breast.
  • Modified radical mastectomy removes the entire breast and some lymph nodes under the arm.

Breast reconstruction after mastectomy may be done at the time of mastectomy or at a future time. Multiple options for reconstruction are available and are considered to be part of the overall cancer treatment plan and not cosmetic surgery. It is therefore usually covered by most insurance plans.

Learn more about Breast Reconstruction

Sentinel Lymph Node Biopsy (SLNB)

Sentinel Lymph Node Biopsy (SLNB) is a surgical procedure used to determine whether the cancer in your breast has spread to the lymph nodes under your arm. The sentinel node which is removed in this procedure is the first node to receive lymphatic drainage from the tumor. If the sentinel node has cancer cells an axillary dissection, a procedure in which more lymph nodes are removed from under the arm may be necessary.

Radioactive Seed Localization (RSL)

What used to begin with the sometimes painful placement of a guide wire in a patient's breast to mark the location of a breast abnormality can now be done with a much more precise and less painful method. The process uses a thin needle to place one or two tiny radioactive seeds – about the size of a grain of rice – directly at the site of the abnormality. The procedure takes about 15 minutes from start to finish with minimal discomfort. The radiation in the seed is not dangerous. It gives off only enough radiation to act as a marker for the surgeon.

The radioactive seed allows the surgeon to accurately remove the abnormal tissue, the seed and ideally, if cancer is found, additional tissue in the margins around the cancer. Radiation or chemotherapy may still be required after surgery. The previous and still most common approach to marking an abnormality that can only be seen through mammography is to place a guide wire in the patient’s breast in the morning, and then have surgery later in the day. By using RSL, discomfort with the wire is eliminated. Additionally, the seeds can be implanted up to five days prior to surgery, offering more scheduling flexibility for patients and surgeons. On the day of surgery, the surgeon uses a detection device that pinpoints the radioactive seeds, identifying the exact location of the abnormality so it can be removed.