Surgery is a vital part of the treatment of breast cancer. Whether you have a small lumpectomy that just removes the cancerous tissue or you opt for a mastectomy which removes the entire breast, it is a surgery that effects your emotions and sense of well being.

There are no right or wrong answers in making your decision. However, some answers are made for you because some tumors simply need a more complete surgical procedure than others.

As always, knowledge is power. Learn as much as you can in order to make an informed decision. By educating yourself you will also learn of the many options there are available to you. Tremendous strides have been made in the treatment of breast cancer and its surgery and reconstruction. There is a lot of hope and optimism out there among all the confusion and fear you may be feeling now.

Let’s start at the beginning.


A lumpectomy removes the tumor and surrounding tissue. It has been proven that a lumpectomy followed by radiation has the same survival rate as a mastectomy. You must decide what you feel comfortable with. If your tumor is small in relation to the size of your breast, then a lumpectomy, or breast conserving surgery, is a good option for you. If your tumor is large, there is chemotherapy that can be administered before surgery, known as neo-adjuvant chemo, which shrinks the tumor making it possible to remove it and still conserve the breast.

A lumpectomy is not recommended if you have cancer in more than one area of the breast or if you have another medical condition, such as Lupus, Scleroderma, or rheumatoid arthritis. If you have a lumpectomy you must be followed with radiation treatments. Radiation effects on women with these conditions, also known as collagen vascular diseases, can result in severe scarring and even ulceration.


A mastectomy removes all the breast tissue from your breast area and the area known as the axilla tail that goes up under your arm. Most surgeons are performing skin sparing mastectomies today. This leaves your skin in tact, while the breast tissue is completely removed underneath it. This procedure then makes reconstruction, should you choose to have it, more natural looking.

Many women opt to have a bilateral mastectomy at the time of their surgery. One side would be removed because of the cancer and the other would be removed prophylactically to protect against further cancer and to also make reconstruction more symmetrical leaving you with matching breasts.

For obvious reasons, the recovery time from a lumpectomy is shorter than for a mastectomy, particularly if you have reconstruction following your mastectomy. But you do heal and get better. Talented breast surgeons can perform lumpectomies without leaving much of a scar at all. And a strong team that combines your breast surgeon and a breast reconstructive surgeon can present you with two, new breasts when you wake up from the anesthesia.

The Sentinel Node Biopsy

A newer and more preferred procedure to test your lymph nodes is the Sentinel Node Biopsy. This was created to minimize the amount of lymph nodes removed because that surgery has the potential to create a serious effect. When you get a full axillary lymph node dissection you are left without any lymph nodes under your arm. Since you don’t have lymph nodes anymore, the lymphatic fluid can sometimes have trouble filtering in your arm and swelling, known as lymphedema, may occur. The theory behind the sentinel node biopsy is that by not removing the entire bundle, you reduce the risk of lymphedema.

Your surgeon will inject a tracer dye into your tumor field to see which node the dye goes to first. That first one is the sentinel node. The nodes surrounding it are then watched to see if they collect the dye as well. Usually two or three are sent dye from the sentinel node. These are removed and tested. If they are clear, the chances are the rest of the nodes in the axillary sac are also clear and no further surgery is required. If there is cancer found in them then the sac will be removed.

Ports and Port Insertion

If you are going to be getting chemotherapy, a port or portacatheter will need to be placed. This saves the veins in your arms from being scarred from the chemicals being administered.

A port is a tube with a drum attached to it. The tube is inserted into your upper chest area, near your collar bone, and into an artery that delivers the medicine to your system. The drum attached to it is placed just under your skin. This is where your oncology team can access the port and draw blood as well as give you your chemotherapy treatments.

Please note: Only special needles can be used with a port. Do not let anyone inexperienced try to access your port or use a traditional needle on it. If you have to go to the hospital ask for someone from the oncology ward or the blood lab who is experienced with ports and who has the proper equipment, do your blood draws.

Side Effect from Surgery: Lymphedema

There is a complication that breast surgery and the removal of lymph nodes can produce. Please see our page on
Lymphedema for complete information. It is important that you learn about it.
Should You Consider a Prophylactic Bilateral Mastectomy?

Contralateral Prophylactic Mastectomy Associated With Survival in Select Breast Cancer Patients
ScienceDaily (Mar. 3, 2010) — Contralateral prophylactic mastectomy (CPM), a preventive procedure to remove the unaffected breast in patients with disease in one breast, may only offer a survival benefit to breast cancer patients age 50 and younger, who have early-stage disease and are estrogen receptor (ER) negative, according to researchers at The University of Texas M. D. Anderson Cancer Center.

Published online February 25 in the Journal of the National Cancer Institute, it's the first population-based study to find an association between the procedure and survival in any group of breast cancer patients. The findings should offer evidence to both the women making this often agonizing decision and the physicians responsible for their care.

According to Isabelle Bedrosian, M.D., assistant professor in M. D. Anderson's Department of Surgical Oncology, a growing number of breast cancer patients are opting for the procedure; recent statistics have shown that the rate of CPM in women with stage I-III breast cancer increased by 150 percent from 1998 to 2003 in the United States.

"In our clinic, we've seen a dramatic increase in the number of women requesting CPM, and across the breast cancer community, studies have shown that the utilization of the procedure is skyrocketing," said Bedrosian, the study's co-corresponding author. "Until now, we've counseled these patients on a very important, personal decision in a vacuum. With our study, our goal was to understand the implications of the surgery and who may benefit."

For the retrospective, population-based study, the researchers used the National Cancer Institute's Surveillance, Epidemiology and End Results (SEER) registry, the premier population-based cancer registry now representing 26 percent of the country's population, to identify 107,106 breast cancer patients who underwent a mastectomy for treatment, as well as a subset of 8,902 women who had CPM. All of the women were treated for stages I -- III breast cancer between 1998 and 2003. Patients were stratified for ER status, stage of disease and age. Breast cancer-specific survival served as the study's primary endpoint.

Rigorous analysis was paramount in the design of the study, said George J. Chang, M.D., assistant professor in M. D. Anderson's Department of Surgical Oncology.

"It was important to take a critical eye and look at all the different ways the data could be misinterpreted to ensure that biases were not impacting our findings," said Chang, the study's co-corresponding author. "Using multi-variable analysis as well as risk stratification, we did our analysis in many different ways -- through SEER, comparing the survival of these patients to that of the general population, as well as examining non-cancer related versus cancer-specific survival. All alternative analyses resulted in the same conclusion; we found one group for whom this surgery offers a true survival benefit."

The researchers found a clear survival benefit for a select group of women that represents less than 10 percent of the breast cancer population. Those younger than age 50 with stage I or II cancer with ER negative disease had a survival benefit of 4.8 percent at five years. However, both Bedrosian and Chang expect that future research will show increased survival benefit with longer follow-up in the population, as a patient's likelihood of getting a second breast cancer increases with time.

While the findings should serve as a guideline for breast cancer patients and their physicians to have an informed, medically-based discussion about CPM, they do not determine that CPM is medically inappropriate for all others with the disease, said the researchers.

"Our research found that breast cancer patients over the age of 60 can be reassured that they will not benefit from CPM," said Bedrosian. "However, there are other populations -- such as women between the age of 50 and 60 -- where the findings about the procedure remain less clear. In addition, for young women with early stage, estrogen receptive positive breast cancer who receive Tamoxifen for only five years, we really do not know whether they would derive a life-long protective effective from a second breast cancer event. Therefore, for some additional breast cancer patients, CPM may very well be a medically-appropriate option."

In addition, the researchers note, the study captured neither family history nor BRCA status; it also did not include DCIS, or stage 0 breast cancer patients.

In addition to Bedrosian and Chang, Chung Yuan Hu in the Department of Surgical Oncology, also authored the all-M. D. Anderson study.

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