Breast cancer surgery

This page was reviewed under our medical and editorial policy by

Daniel Liu, MD, Plastic and Reconstructive Surgeon

This page was reviewed on February 18, 2022.

Almost all women who have breast cancer undergo some form of surgery as part of their personalized treatment plan, but the type of breast cancer surgery you have depends on your specific situation.

For example, surgery may be done to:

  • Remove cancer
  • Alleviate symptoms
  • Learn if the cancer has spread
  • Reconstruct the breast after removal

Whenever possible, and depending on individual preferences, our City of Hope surgeons perform breast-conserving surgery (also known as breast conservation therapy). We also provide a range of advanced surgical techniques for breast reconstruction.

We recognize that breast cancer surgery is a personal decision that can often be complex and overwhelming. Your care team will help you understand all your breast cancer surgery options, so you can decide on an individualized treatment plan tailored to you and your needs.

Breast cancer surgeries include:

Breast conservation therapy (lumpectomy): This procedure removes a tumor from the breast. A lumpectomy differs from a mastectomy, which removes the entire breast. Women who undergo a lumpectomy are usually recommended to receive radiation therapy following surgery to help prevent recurrence. Some women are candidates for intraoperative radiation therapy, which typically limits the amount of radiation treatments needed after surgery. Commonly referred to as breast conservation therapy, a lumpectomy when coupled with radiation therapy is designed to allow a woman to keep her breast.

Mastectomy: This is the surgical removal of all the breast tissue. If breast conservation therapy is not a viable option, mastectomy may be recommended. Women who have cancer in multiple areas of the breast and/or large tumors relative to the size of the breast are typically recommended to undergo a mastectomy. Women with certain genetic mutations (BRCA1 or BRCA2) may also be recommended for a mastectomy.

In many instances, much of the breast skin and even the nipple may be spared to improve the outcome of reconstruction.

There are several different types of mastectomy:

  • Nipple-sparing mastectomy, where only the breast tissue is removed
  • Skin-sparing mastectomy, where the breast tissue is removed with the nipple and areola
  • Total (simple) mastectomy, where the breast tissue and skin are removed
  • Modified radical mastectomy, where the whole breast is removed, along with the lymph nodes under the arm

Factors such as breast size, breast shape, type of cancer and the location of cancer in the breast and/or lymph nodes will determine which type of mastectomy is performed. Your breast surgeon will guide you through the decision-making process.

Mastectomy vs. lumpectomy

Deciding whether to have a lumpectomy or a mastectomy is a personal choice that depends on many factors, including your preferences.

Having a lumpectomy will leave most of your breast tissue in place, and it may work well if your cancer is caught early. This type of surgery is likely to be done in addition to radiation in order to minimize the chances of cancer recurring.

A mastectomy may be advised if:

  • Tumor is large
  • You’ve already undergone other breast cancer treatments
  • You’re concerned the cancer may return

According to the American Cancer Society, survival rates in women who have breast-conserving surgery along with radiation are identical to survival rates in women who have a mastectomy when they’re candidates for either procedure. Be sure to speak with your doctor about the benefits and risks for you, along with your anticipated recovery time and postsurgical pain management options.

Breast reconstruction after breast cancer surgery

After having surgery for breast cancer, many reconstructive options to rebuild your breast may be available to you. Whether or not you’re a candidate for breast reconstructive surgery depends on some of your health factors and personal preferences. Be sure to ask your surgical team about reconstruction before undergoing breast cancer surgery, because the type of surgery you have affects your reconstructive options.

Sometimes, reconstruction can be done during your breast cancer surgery (immediate reconstruction), or it may need to be done after you’ve healed from your initial cancer surgery and treatments (delayed reconstruction). If you’re also undergoing radiation therapy for breast cancer, you may have to wait before undergoing reconstruction.

Health complications caused by poor circulation, diabetes or smoking may interfere with healing, also delaying reconstructive surgery options. If you’re too thin or obese, you may not qualify to have certain types of breast reconstruction surgery.

Having breast reconstruction may help you feel more confident after a mastectomy or lumpectomy. But it’s important to understand that reconstruction doesn’t usually make the patient’s breasts look the same as they did prior to cancer surgery.

Having reconstructive surgery is a personal choice, which may depend on:

  • How quickly you’d like to recover after surgery
  • Whether or not you’re open to having more than one reconstructive surgery
  • How it may affect your overall life

Be sure to discuss the risks, benefits and possible outcomes with your cancer care team.

If you have a lumpectomy, your surgeon may reshape your breast using plastic surgery techniques at the same time as your breast cancer surgery, called oncoplastic surgery.

If you’re a candidate for reconstruction following lumpectomy or mastectomy, you may be offered one or more of the following procedures over time:

  • Placement of breast implants
  • Fat grafting from the hips, buttocks, abdomen or thighs
  • Breast reduction to even the breast’s appearance
  • Breast lift
  • Surgical scar revision
  • Breast flaps using your own tissue
  • Nipple or areola reconstruction

Your individual options depend on:

  • Your cancer’s stage and extent
  • The kind of breast cancer surgery you’re having
  • Any other cancer treatments you may need to complete in the future
  • Your overall health

Learn about breast reconstruction after mastectomy

Sentinel lymph node biopsy

Depending on the stage of the breast cancer, your surgeon may recommend an axillary sentinel lymph node biopsy as part of your breast cancer surgery.

In an axillary sentinel lymph node, the surgeon removes the first lymph nodes under the arm (axilla) to which breast cancer cells may spread from the primary tumor location.

This procedure:

  • Helps to evaluate the extent of disease and assists the oncologist in determining whether chemotherapy or radiation therapy is required
  • Helps the surgeon determine whether an axillary lymph node dissection is needed
  • May potentially avoid unnecessary removal of lymph nodes in the axilla, helping to reduce both the length of surgery and the risk of developing lymphedema, a condition in which fluids builds up in the extremities

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