Surgical Options

Surgery is often a part of treatment for breast cancer, although in certain cases of metastatic breast cancer, surgery on the tumor in the breast may not be recommended. There are a variety of surgical procedures that may be used.

Mastectomy & lumpectomy

Surgery on the breast may be breast-conserving or a mastectomy. A mastectomy removes the entire breast.

Figure 1. Mastectomy

Mastectomy

Partial mastectomy

A partial mastectemy is also called a segmental mastectomy or quadrantectomy, a procedure in which a portion of the breast tissue is removed.2

In addition to mastectomies, there are several different types of procedures used to treat breast cancer, including:

Lumpectomy

A lumpectomy is a breast-conserving surgery that removes cancerous tissue and a layer of healthy cells but aims to preserve the appearance of the breast.1

Figure 2. Lumpectomy

Lumpectomy

Skin-sparing mastectomy

A skin-sparing mastectomy is a procedure in which breast tissue is removed, but the skin of the breast is spared.3

Figure 3. Skin-sparing mastectomy

Skin-Sparing Mastectomy

Nipple-sparing mastectomy

A nipple-sparing mastectomy is a procedure in which breast tissue is removed, but the nipple and areola are spared.4

Figure 4. Nipple-sparing mastectomy

Nipple-Sparing Mastectomy

Modified radical mastectomy

A modified radical mastectomy is a procedure in which the entire breast, skin, nipple, areola, and many axillary lymph nodes are removed.5

Figure 5. Modified radical mastectomy

Modified Radical Mastectomy

Reconstructive surgery

Reconstructive surgery is a type of plastic surgery that is used to rebuild the shape of the breast tissue and may be used by women who have had a mastectomy or a lumpectomy. While lumpectomy is a breast-conserving procedure, some women may not feel comfortable with the appearance of their breast after lumpectomy and may benefit from reconstructive procedures. Reconstructive surgery may be performed at the time of the initial breast cancer surgery, or it may be delayed months or years after the initial surgery. In some cases, reconstruction may take multiple procedures.6

Implants or flap procedures

Reconstructive surgery may involve implants or flap procedures, or a combination of the two. Flap procedures use tissue from another part of the patient’s own body to reconstruct the breast mound and include7:

  • TRAM (transverse rectus abdominis muscle) flap, which uses a portion of the skin, fat, muscle, and blood vessels from the lower abdomen
  • DIEP (deep inferior epigastric perforator) flap, which uses fat and skin from the lower abdomen, but not muscle tissue to help form the breast mound like a TRAM flap
  • SIEA (superficial inferior epigastric artery) flap, which also uses fat and skin from the lower abdomen, but uses different blood vessels than the DIEP procedure
  • Latissimus dorsi flap, which uses muscle, fat, skin, and blood vessels from the upper back
  • GAP (gluteal free) flap, which uses skin, fat, and blood vessels from the buttocks
  • TUG (transverse upper gracilis), or inner thigh, flap, which uses skin, muscle, fat, and blood vessels from the inner thigh

Figure 6. Breast reconstruction options

Reconstructive Surgery

Other surgical procedures

In addition to surgery to the breast, women with breast cancer may have other surgical procedures, including:

Axillary lymph node dissection

An axillary lymph node dissection is a surgical procedure in which several lymph nodes are removed from the underarm and tested for the presence of cancer.8

Figure 7. Axillary lymph node dissection

Lymph Node Dissection

Sentinel lymph node biopsy

A sentinel lymph node biopsy is a procedure in which a radioactive dye is injected into the breast to determine the first one to several lymph nodes that are the primary drainage point for the breast – these sentinel nodes are then removed to test for the presence of cancer.9

Figure 8. Sentinel lymph node biopsy

Sentinel Lymph Node Biopsy

Oophorectomy or ovarian ablation

An oophorectomy is a surgical removal of the ovaries.10

Surgery for metastatic breast cancer

The primary treatment for metastatic breast cancer will typically involve a systemic treatment, such as chemotherapy, targeted therapy, and/or hormone therapy. Surgery to remove the primary tumor in the breast is controversial, with some research studies finding that removing the primary tumor can potentially improve survival and other studies finding little benefit. Women with metastatic breast cancer should discuss their options with their doctor to determine the best treatment options for them.11,12

When breast cancer has spread to distant parts of the body, surgery is not usually used to remove these metastases. However, one small study found that certain women with metastases to the liver may benefit from having them surgically removed if the cancer is hormone receptor-positive (HR+), responded to chemotherapy prior to surgery, and didn’t increase in size between diagnosis of metastases and surgery. It isn’t yet known if surgery to remove liver metastases improves patient outcomes, and women should talk to their doctor about whether this is a potential option in their case.13

Written by: Emily Downward | Last reviewed: December 2018.
View References
  1. Lumpectomy. Mayo Clinic. Available at https://www.mayoclinic.org/tests-procedures/lumpectomy/about/pac-20394650. Accessed 10/5/18.
  2. Partial mastectomy. PubMed Health. Available at https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0030264/. Accessed 10/5/18.
  3. Skin-sparing mastectomy. BreastCancer.org. Available at https://www.breastcancer.org/treatment/surgery/mastectomy/skinsparing. Accessed 10/5/18.
  4. Nipple-sparing mastectomy. Stony Brook University Hospital. Available at https://www.stonybrookmedicine.edu/patientcare/surgery/patient-care/clinical/breast-surgery/patient-education/faqs-about-nipple-sparing-mastectomy. Accessed 10/5/18.
  5. Kuwajerwala NK. Modified radical mastectomy. Medscape. Available at https://emedicine.medscape.com/article/1830105-overview. Accessed 10/5/18.
  6. Should I get breast reconstruction surgery? American Cancer Society. Available at https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/should-i-get-breast-reconstruction-surgery.html. Accessed 10/16/18.
  7. Breast reconstruction using your own tissues (flap procedures). American Cancer Society. Available at https://www.cancer.org/cancer/breast-cancer/reconstruction-surgery/breast-reconstruction-options/breast-reconstruction-using-your-own-tissues-flap-procedures.html. Accessed 10/16/18.
  8. Lymph node surgery for breast cancer. American Cancer Society. Available at https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/lymph-node-surgery-for-breast-cancer.html. Accessed 10/8/18.
  9. Sentinel lymph node biopsy for early stage breast cancer. American Society of Clinical Oncology. Available at https://www.cancer.net/research-and-advocacy/asco-care-and-treatment-recommendations-patients/sentinel-lymph-node-biopsy-early-stage-breast-cancer. Accessed 10/8/18.
  10. Endocrine therapy for premenopausal women. John Hopkins Medicine. Available at https://www.hopkinsmedicine.org/kimmel_cancer_center/centers/breast_cancer_program/treatment_and_services/survivorship/endocrine_therapy/premenopausal_women.html. Accessed 10/8/18.
  11. Tosello G, Torloni M, Mota BS, Neeman T, Riera R. Breast surgery for metastatic breast cancer. Cochrane. Available at https://www.cochrane.org/CD011276/BREASTCA_breast-surgery-metastatic-breast-cancer. Accessed 10/5/18.
  12. Poggio F, Lambertini M, de Azambuja E Controversies in Oncology: Surgery of the primary tumour in patients presenting with de novo metastatic breast cancer: to do or not to do? ESMO Open 2018;3:e000324. doi: 10.1136/esmoopen-2018-000324
  13. Surgery to treat metastatic breast cancer. BreastCancer.org. Available at https://www.breastcancer.org/symptoms/types/recur_metast/treat_metast/options/surgery. Accessed 10/5/18.