Surgery for breast cancer will involve either breast conserving surgery, where part of the breast is removed, or mastectomy, where the whole breast is removed. In most cases, breast surgery also involves removing one or more lymph nodes from the armpit.
Learn more about:
- Which surgery should I have?
- Breast conserving surgery
- Breast reconstruction
- Removing lymph nodes
- What to expect after breast surgery
- What to expect when you get home
- Side effects of surgery
- Video: What is surgery?
Which surgery should I have?
Some women will be offered a choice between breast conserving surgery and a mastectomy. Men don’t usually have breast conserving surgery.
Research has shown that breast conserving surgery with sentinel lymph node biopsy, followed by radiation therapy, is as effective as mastectomy for most women with early breast cancer. The chance of a recurrence is the same regardless of which surgery you have.
The operations for breast cancer have different benefits, side effects and risks. The images below show some examples of the various options, but talk to your doctor about which one is best for you.
Top left, top right, bottom left – supplied by Dr James French, Westmead Breast Cancer Institute, NSW
Bottom right – reproduced with permission from Breast Cancer: Taking Control, © Boycare Publishing 2010
Breast conserving surgery
Surgery to remove the breast cancer and some surrounding healthy tissue is called breast conserving surgery. It is also called lumpectomy or wide local excision. Breast conserving surgery is recommended if the cancer is small compared to the size of your breast.
The surgeon removes the smallest amount of breast tissue possible. This will leave a scar and may change the size and, potentially, the shape of the breast, and it may affect the position of the nipple.
Oncoplastic breast conserving surgery
Oncoplastic breast conserving surgery combines oncological surgery (to remove the cancer) with plastic surgery (to reshape the breast and preserve its appearance as much as possible). This specialised surgical technique is performed by oncoplastic breast surgeons and some breast surgeons.
The removed breast and lymph node tissue is sent to a laboratory. A specialist called a pathologist checks it under a microscope to see if there is an area of healthy cells around the cancer – this is known as a clear margin. The pathologist will create a report, which will include information about the size and grade of the cancer, whether it has spread to any lymph nodes (the stage), whether the margins contain cancer cells, and whether the cells are hormone and/or HER2 receptor positive or negative.
If cancer cells are found at the edge of the removed tissue (an ‘involved’ or ‘positive’ margin), there is a greater chance of the cancer returning. You may need more tissue removed (re-excision or wider excision), or your doctor may recommend you have a mastectomy.
After breast conserving surgery, radiation therapy to the whole breast is usually recommended to destroy any undetected cancer cells that may be left in the breast or armpit, and to keep the cancer from coming back (recurrence). For some women, radiation therapy may not be required.
Some women also need chemotherapy, targeted therapy or hormone therapy.
Surgery to remove the whole breast is called a mastectomy. You may be offered a mastectomy if:
- there is cancer in more than one area of the breast
- the cancer is large compared to the size of the breast
- you have had radiation therapy to the same breast before and so cannot have it again
- clear margins cannot be obtained after one or two breast conserving procedures.
You may decide that you would prefer to have a mastectomy rather than breast conserving surgery, particularly if you are unable to have radiation therapy. Some women choose to have a mastectomy even if the cancer is very small.
During a mastectomy, the nipple and some or all of the lymph nodes in the armpit closest to the affected breast are also usually removed.
In some cases, the surgeon may be able to perform a skin-sparing or nipple-sparing mastectomy. This means that more of the normal skin – with or without the nipple – is kept. This allows the surgeon to do an immediate breast reconstruction. The reconstruction may be done with either a temporary implant (tissue expander) or a permanent implant, or it may use tissue from another part of your body.
If you don’t have an immediate reconstruction, you can wear a soft breast form inside your bra while your surgical wound heals. After this time, you can be fitted for a permanent breast prosthesis.
A breast reconstruction is a type of surgery in which a breast shape is created using a silicone or saline implant, tissue from another part of your body, or a combination of both.
Some women have a breast reconstruction at the same time as a mastectomy (immediate reconstruction). Others are advised or prefer to wait for several months or longer before having a reconstruction (delayed reconstruction). Some women choose not to have a reconstruction at any stage.
If you’re not having an immediate reconstruction but you think you might consider it in the future, mention this to your surgeon before surgery, as it will help them to plan the mastectomy.
For more information about breast reconstruction, talk to your surgeon, call Cancer Council 13 11 20, or read Breast Prostheses and Reconstruction.
Removing lymph nodes
The lymph nodes in the armpit are often the first place breast cancer cells spread to outside the breast. To see whether the cancer has spread, some or all of the lymph nodes are removed and checked for cancerous cells. The operation is called axillary surgery. It is usually performed during breast surgery, but it may be done in a separate operation. There are different types of axillary surgery.
Sentinel node biopsy
The first lymph node that breast cancer cells may spread to outside the breast is the sentinel node. There can be more than one sentinel node. Usually it is in the armpit, but it can also be found near the breastbone (sternum).
The process of finding the sentinel node involves these steps:
- A small amount of radioactive material is injected into the breast around the nipple and areola before surgery.
- A scan is taken to show which node the substance flows to first.
- During surgery, a blue dye is injected around the areola or near the cancer. The dye moves into the lymphatic vessels.
- The nodes that are radioactive or become blue first are the sentinel lymph nodes. The surgeon will remove them for testing.
If the sentinel nodes are clear of cancer cells, no further surgery is needed. If one or more sentinel nodes contain cancer cells, axillary dissection or radiation therapy to the armpit may be considered.
Sentinel node biopsy can cause similar side effects to axillary dissection, but they are usually less severe.
Axillary dissection (clearance)
The surgeon will remove most or all of the lymph nodes (usually 10–20 nodes). If cancer cells are present, your doctor may recommend further treatment with chemotherapy, targeted therapy or hormone therapy.
Possible side effects of axillary dissection include:
- arm or shoulder stiffness
- numbness in the arm, shoulder, armpit and parts of the chest
- seroma (fluid collecting near the surgical scar).
Your surgeon will discuss these side effects with you before the operation.
What to expect after breast surgery
The length of your hospital stay will depend on the type of breast surgery you have and how well you recover. Most people are able to walk around and shower the day after surgery.
Tubes and dressings
You may have one or more drainage tubes in place to remove fluid from the surgical site. These may remain for up to two weeks, depending on the type of surgery. A dressing will cover the wound to keep it clean, and it will usually be removed after about a week.
Some people are discharged from hospital with drains still in place, but this will depend on your situation and your doctor’s advice. Nursing staff will teach you how to manage the drains at home, or you may be referred to a community nurse or your GP.
While you are in hospital, it’s important to move your legs when you are in bed to help prevent blood clots. When you are able, get up and walk around. You may have to wear graduated compression stockings or use other devices to help prevent blood clots in the deep veins of your legs (deep vein thrombosis or DVT). Your doctor might also prescribe you medicine that lowers the risk of clots.
You will be given pain relief through an intravenous (IV) drip, via an injection, or as tablets, and you will be given pain medicine when you go home. Any bruising and swelling at the surgery site will usually settle down in 2–3 weeks.
Sense of loss
Breast surgery may change the appearance of your breast, and this can affect how you feel about yourself (self-image and self-esteem). You may feel a sense of loss if you’ve had a mastectomy. It is normal to grieve the loss of your breast.
If you have any questions about your recovery, ask the doctors and nurses caring for you. Many people are referred to a breast care nurse for information and support.
What to expect when you get home
Recovering from breast surgery will take time. If you need home nursing care, ask hospital staff about services that are available in your area.
Caring for the wound
- Seek advice – Talk to your surgeon and breast care nurse about the best way to look after the wound.
- Avoid cuts – If you shave your armpits, use a mirror so you can see what you are doing to avoid cutting yourself.
- Bathe carefully – Keep the wound clean, and gently pat it dry after showering.
- Comfort first – Wear a bra or soft crop top when it is comfortable to do so.
- Follow-up – Report any redness, pain, swelling or wound discharge to your surgeon or breast care nurse.
- Moisturise – Gently massage the area with moisturiser once the stitches have been removed and the wound has completely healed.
- Don’t use deodorant – If the wound is under your arm, avoid using deodorant until it has completely healed.
Getting back on your feet
- Recovery time – The time it takes to recover from breast surgery varies between people. Most people start to feel better within about two weeks.
- Get help – Ask friends or family to help you out while you recover, e.g. with household chores.
- Rest up – Get plenty of rest in the first few days after being discharged from hospital. Take it easy and only do what is comfortable.
- Resuming activities – Check with your surgeon and/or breast care nurse about when you can start doing your regular activities. For example, some surgeons tell you to avoid driving until the stitches are removed or until your arm is more agile.
- Arm exercises – After surgery, you can slowly begin to exercise your arm on the advice of your treatment team. This will help it feel better and get back to normal more quickly. Arm exercises will also move any fluid that has collected near the surgical scar (seroma) and help to prevent lymphoedema. See Cancer Council’s Exercises after breast cancer surgery poster for a guide to arm exercises you can try.
Side effects of surgery
Talk to your doctor or breast care nurse about ways to deal with the side effects of surgery. Most side effects can be managed. See After treatment for tips.
- Fatigue – Feeling tired and having no energy is common. Cancer treatment and the emotional impact of the diagnosis can be tiring. Fatigue may continue for a few weeks or months.
- Shoulder stiffness – Gentle exercises can help prevent or manage shoulder stiffness. Ask your breast care nurse, a physiotherapist or an occupational therapist about suitable exercises.
- Numbness and tingling – Surgery can cause bruising or injury to nerves, which may cause numbness and tingling in the chest and arm. This often improves within a few weeks, but it may take longer. For some people, it may not go away completely. A physiotherapist or occupational therapist can suggest exercises that may help.
- Seroma – Fluid may collect in or around the surgical scar. A breast care nurse, your specialist or GP or a radiologist can drain the fluid using a fine needle and syringe. This procedure isn’t painful, but it may need to be repeated over a few appointments.
- Change in breast, nipple or arm sensation – This is usually temporary, but it may be permanent for some people.
- Lymphoedema – Fluid build-up may cause swelling after lymph node surgery.
Video: What is surgery?
Watch this short video to learn more about surgery.