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Breast Cancer Treatment: Surgery

Most patients will have surgery to remove cancer from the breast. Lymph nodes under the arm are usually removed at the same time. A pathologist will examine the lymph nodes under a microscope to see if they contain cancer, an indicator as to how far the cancer has advanced.

There are two types of surgical treatment for breast cancer: breast-conserving therapy and mastectomy.

Breast-conserving therapy includes an operation to remove the cancer, but not the breast itself. Two forms of breast-conserving surgery include:

  • Lumpectomy:
    Removes the tumor (lump) and a small amount of normal tissue around it.
  • Partial mastectomy:
    Removes the part of the breast that has cancer and some normal tissue around it. This procedure is also sometimes referred to as a segmental mastectomy.

Patients who are treated with breast-conserving surgery typically have several of the lymph nodes under the arm removed for biopsy. This is called a lymph node dissection. It may be done at the same time as the breast-conserving surgery or after. Lymph node dissection is done using a separate incision.

The University of Michigan Comprehensive Cancer Center offers patients the option of having their tissue samples examined microscopically while they are still under anesthesia. Traditionally, patients have to wait several days for standard laboratory processing to evaluate whether surgery removed all of the cancer. If not, another surgery would be scheduled to remove more tissue or lymph nodes.

At U-M's East Ann Arbor Ambulatory Surgery Center, a laboratory next to the operating rooms allows pathologists to evaluate tissue samples during surgery. Based on the lab’s findings, surgeons can decide to remove additional tissue or lymph nodes during the same surgery. This approach reduces the likelihood of additional surgery, improves patient care and outcomes and reduces the overall cost of care.

Mastectomy removes the breast completely. There are several types of mastectomy:

  • Modified radical mastectomy:
    Removes the whole breast with cancer, many of the lymph nodes under the arm, the lining over the chest muscles and sometimes part of the muscles on the chest wall.
  • Radical mastectomy:
    Removes the breast with cancer, chest wall muscles under the breast and all of the lymph nodes under the arm. This procedure is sometimes also referred to as a Halsted radical mastectomy.
  • Total mastectomy:
    Removes the whole breast with cancer. This procedure is also sometimes called a simple mastectomy. Some of the lymph nodes under the arm may be removed for biopsy at the same time as the breast surgery or after.

If a patient is going to have a mastectomy, breast reconstruction (surgery to rebuild the breast shape) may be considered. Breast reconstruction can be done at the time of the mastectomy or in the future. The reconstructed breast may be made with the patient’s own (non-breast) tissue or by using implants filled with saline or silicone gel.

To learn more about breast reconstruction visit the University of Michigan Department of Surgery Breast Reconstruction Web site.

To learn more about surgery for breast cancer, visit the National Cancer Institute’s guide on Surgery Choices for Women with Early Stage Breast Cancer -opens as a .pdf document.

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