What are the different types of breast cancer surgery?

A lumpectomy procedure removes cancer but leaves most of the healthy breast tissue intact. In some people, the surgeon may also remove the lymph nodes for a biopsy.

A surgeon may also remove part of the chest wall lining as a precaution if the tumor is particularly close to it.

A total or simple mastectomy procedure removes the entire breast and some lymph nodes.

A modified radical mastectomy is the same, but a surgeon also removes part of the chest wall muscle. A person may want reconstructive surgery during or after a mastectomy.

According to the American Cancer Society (ACS), many people with early stage breast cancer can choose between mastectomy or breast-conserving surgery (BCS). BCS is sometimes called a partial mastectomy or lumpectomy. A lumpectomy will preserve most of the breast. However, doctors usually follow a lumpectomy with radiation therapy to make sure the remaining cancer cells are destroyed.

Those with early stage breast cancer who opt for a mastectomy are not as likely to need radiation therapy. A mastectomy may be a more appropriate option depending on the type of cancer, the size of the tumor, and previous radiation therapy treatment.

As with a lumpectomy, a person may also need additional treatment after a mastectomy. This could include chemotherapy, hormone therapy, and targeted therapy, especially if the cancer is at an advanced stage.

Some people may be concerned that not opting for a mastectomy makes it more likely that the cancer will return. The ACS reports that the survival rate is the same for those who undergo a lumpectomy combined with radiation and those who opt for a mastectomy.

The National Cancer Institute notes that most people with ductal carcinoma in situ (DCIS) may prefer a lumpectomy to preserve as much of the breast as possible. DCIS is when the cancer is in the milk ducts only and has not spread elsewhere.

However, some people with DCIS may prefer a mastectomy. They may choose this option if:

• their breasts are smaller
• DCIS and other breast cancer cells are in most of the breast
• DCIS or breast cancer is in multiple areas of the breast
• DCIS or breast cancer is under the nipple
• they cannot receive radiation therapy

Surgeons tend to recommend a simple mastectomy for males with breast cancer, as they have less breast tissue.

Learn more about breast lump removal here.

A person can choose to have surgery to reconstruct the breast and nipples. If a person does not want to undergo breast reconstruction surgery, they can use prosthetics or opt for no surgery at all. It is important to discuss these options with a healthcare professional.

According to Breastcancer.org, there are two techniques to reconstruct the breast — implant reconstruction and autologous reconstruction.

An implant reconstruction is when a surgeon inserts an implant that contains saline or silicone gel. An autologous reconstruction uses tissue from other parts of the body.

A person can choose to undergo breast reconstruction at the same time as the mastectomy. However, they can also opt for delayed breast reconstruction. This might be an option if a person requires additional treatment after surgery, such as radiation therapy or chemotherapy.

If a person has undergone a lumpectomy or partial mastectomy, a surgeon may recommend oncoplastic surgery. This can help to reshape the breast and may include:

• smaller implants
• breast reduction
• fat grafting
• breast lift

Learn more about breast reconstruction surgery here.

Nipple and areola reconstruction

This is typically the final stage of breast reconstruction and takes place 3–4 months after the initial surgery.

A surgeon can use tissue from the breast or other part of the body to create a nipple. Some people may choose to get a tattoo.

The recovery times for the following breast cancer surgeries are:

• Lumpectomy: Most people can get back to day-to-day activities within 5–10 days.
• Mastectomy: People may feel back to themselves 3–4 weeks after surgery.
• Mastectomy with reconstruction: This procedure has the longest recovery time, and takes up to 6–8 weeks.

There are side effects with all surgeries, and breast cancer surgery is no different.

The following side effects of these surgeries are:

• Lumpectomy: A person may feel tired and notice their skin itches or peels after radiation therapy.
• Mastectomy: A person may feel off balance and experience shoulder and neck pain while they adjust to carrying less weight on their chest. People with larger breasts may notice this more.
• Mastectomy with reconstruction: People may not like how the new breast looks. If they received an implant, the breast could toughen and harden, causing pain. A person may also need additional surgery if the implant splits in the future.

When breast cancer starts to spread, the cancer cells typically go to the lymph nodes under the arm first. To understand and monitor cancer progression, a surgeon may perform either a sentinel lymph node biopsy (SLNB) or an axillary lymph node dissection (ALND).

Sentinel lymph node surgery (SLNB)

A surgeon injects a radioactive dye into the tumor and the area around it. The dye then follows the path the cancer cells would take as they spread around the body. The first lymph nodes the dye reaches are the sentinel lymph nodes.

The surgeon cuts the skin where the lymph nodes are and removes several for analysis. If cancer cells are present, they may follow up with an ALND.

Axillary lymph node dissection (ALND)

According to the ACS, in this procedure, a surgeon removes between 10–40 lymph nodes at a time, although it is usually less than 20. When a person has a lumpectomy or mastectomy, a surgeon may do an ALND at the same time.

A person may need an ALND if:

• the SNLB detected cancer in three or more lymph nodes
• the growth of cancer suggests it could go beyond the lymph nodes
• the SNLB detected cancer cells after chemotherapy

The University of Michigan in Ann Arbor notes that the recovery time for a lymph node dissection varies, and a wound may still leak fluid for 2–3 weeks after the operation.

A surgeon will place a drain in the armpit area to collect the fluid and will remove it when it contains less than 30 cubic centimeters (ccs) for 2 days. A person can remove the gauze covering the wound after 48 hours.

Side effects

The side effects of lymph node surgery include:

• limited movement or pain when moving the shoulder or arm
• numbness in the upper arms
• fluid buildup in the arms and hands

As with any surgical procedure, a person is at risk of bleeding, blood clots, and infection after undergoing lymph node surgery.

The cost of breast cancer surgery varies depending on hospital location and the stage of the breast cancer.

A 2016 study reported that the average per-patient allowed costs from insurance companies over the first 12 months after diagnosis were:

Lower cost options

The Centers for Disease Control and Prevention (CDC) provide a breast cancer screening program called the National Breast and Cervical Cancer Early Detection Program (NBCCEDP).

This service provides breast cancer screening procedures for those who:

• do not have insurance
• have a yearly income that is below 250% of the federal poverty level
• are aged between 40–64 years

The Breast and Cervical Cancer Prevention and Treatment Act in 2000 allowed states to offer treatment through Medicaid to those who received a breast cancer diagnosis through the NBCCEDP program.

Medicare may also cover the cost of breast cancer surgery.

Learn more about medicare and breast cancer surgery here.

A surgeon performs a lumpectomy and a mastectomy to remove cancer from the breast.

Doctors usually request lymph node surgery to monitor cancer progression and gauge the spread of cancer cells.

Males and females with more advanced cancer usually undergo mastectomy, where a surgeon removes the entire breast and sometimes part of the chest wall muscle. A lumpectomy leaves healthy breast tissue intact, so the recovery time is shorter than a mastectomy. The location of the hospital and the stage of breast cancer influence the cost of breast cancer surgery.