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Breast Cancer Surgery 101: What Should You Know?

Breast Cancer Surgery 101: What Should You Know?

Reviewed by Jasper Clinical Board

Last updated 5/24/21


Who needs this kind of breast surgery?

There’s actually a wide range of reasons that people have parts or all of their breasts removed beyond breast cancer, including chronic breast pain and fibrocystic breast disease. People may also choose to get a mastectomy as a precaution if they’re at high risk due to personal history (e.g. a previous bout with breast cancer) or genetic background (e.g. certain mutations in BRCA1 / BRCA2—the so-called breast cancer genes). But across the board, a cancer diagnosis is the most common reason these procedures are performed.
Even so, it’s important to understand that there are many different types of breast surgeries. The exact type you get will depend on your age, overall health, the size and stage of your cancer, and a variety of other factors. Let’s explore the options you and your healthcare team will choose from.

What are your surgical options?

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Lumpectomy

A lumpectomy—also called breast-conserving surgery (BCS)—is the least invasive of all options. It removes only the tumor and a small amount of healthy breast tissue that surrounds it. For many people, this is appealing for obvious reasons. A lumpectomy is typically combined with internal or external radiation treatment to make sure any remaining cancer cells are destroyed. Note that this can sometimes leave a small divot or dimple in the breast.

Nipple-sparing mastectomy

This sophisticated new treatment (sometimes called subcutaneous mastectomy) allows the surgical team to remove part of the breast while still preserving the skin of the breast as well as the nipple and areola. Of course, that’s a big benefit If you’re considering reconstructive breast surgery after your mastectomy. (More on that shortly.)

Skin-sparing mastectomy

This option preserves much of the breast skin (which, again, is valuable for breast reconstruction), but removes the nipple and areola. In some cases, a surgeon will not be sure whether the nipple can be preserved until beginning surgery.

Total (aka “simple”) mastectomy

A total mastectomy (also called a simple mastectomy) is the complete removal of breast tissue. That includes the nipple, areola, and some of the skin of the breast. If you’re seeking a prophylactic mastectomy (i.e. to prevent breast cancer from ever occurring), this is the type of surgery you will probably get. A “double mastectomy” is when you remove both breasts in this fashion.

Radical mastectomy

A radical mastectomy removes the entire breast as well as the muscle tissue beneath it and lymph nodes around the breast and the armpit. This type of procedure has become increasingly rare, and generally is used only if cancer has spread to the muscles beneath the breast.

Modified radical mastectomy

As the name suggests, this procedure is similar to a radical mastectomy. In this case, the breast and lymph nodes are removed while the underlying muscle tissue is spared. 

Other treatments that support mastectomy

Your healthcare team may recommend a mastectomy as your sole treatment, or they may suggest an additional kind of treatment to make sure the cancer is completely destroyed. This is called adjuvant therapy. Here are the most common ones you’ll hear about:
  • Chemotherapy: Powerful medication is infused, injected, or swallowed over the course of weeks or months to kill cancer directly.
  • Radiotherapy: The area is treated with a blast of cancer-killing radiation—either from an external beam or from a radioactive implant.
  • Hormone therapy: Sometimes, your natural hormones like estrogen will cause breast cancer to grow. Medication like Tamoxifen can block this effect. Typically this therapy would continue for 5 or 10 years.
  • Immunotherapy: This relatively new and high-tech therapy helps your body’s natural immune system zero in on and kill cancer cells.
  • Targeted therapy: This cutting-edge treatment deploys a special medication that seeks out cancer cells and blocks their growth. It’s typically injected and often used alongside chemotherapy.

What is the procedure like?

Before your breast surgery, it’s essential to follow all of your healthcare team’s instructions. That may mean adjusting your use of other medicines, vitamins, and supplements. It’ll also mean not eating or drinking for 8-12 hours before surgery. Your team will also tell you if you should plan for an overnight stay, in which case you’ll want to bring comfy clothes, toiletries, and something to pass the time.
When you arrive at the hospital, you’ll be brought to a pre-operative room. Here, you’ll change into a paper gown. A nurse may use a soft, felt-tipped marker to mark your skin where the surgical incisions will be made. When the procedure is about to begin, you’ll be given a general anesthetic and fall into a deep-sleep state. From this point on, you’ll be completely unconscious, so the surgery itself will be painless.
The typical breast surgery takes 2-3 hours—but plan for more if you’re getting a double mastectomy or immediate breast reconstruction (more on that shortly). Afterward, you’ll be taken to a recovery room where your healthcare team will watch over you as you awaken. You may have some pain or numbness in the breast and underarm area, which will be lightly bandaged. 
Your team will then discuss post-surgery care with you—including how to clean and wash the area, as well as safe clothing to wear. They may also send you home with pain medication and antibiotics for the healing process.

What about reconstruction?

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Whether to get breast reconstruction surgery (and which type to get) is a major discussion among people who get mastectomies. 
For some, reconstruction is a wonderful way to maintain a body shape they like, to keep their clothing fitting properly, or just to continue feeling “normal” after surgery. For others, the potential side effects aren’t worth it. That includes a higher risk of infection, additional recovery time, and greater financial burden. Some people simply find “going flat” liberating, and are happy to be done with their breasts forever. 
Ultimately, of course, it’s a very personal decision. Currently, about 40% of patients choose to get reconstructive surgery. If you think you might be interested, talk to your healthcare team about it as early as possible! They’ll figure out whether you’re a good candidate for breast reconstruction, and can connect you with a plastic surgeon.
If you do opt for reconstruction, you’ll choose between immediate and delayed surgery. Immediate reconstruction means it happens during the same operation as your mastectomy. After your cancer surgeon completes the mastectomy, your plastic surgeon takes over and does the reconstruction. You stay under anesthesia the whole time. 
Delayed reconstruction, on the other hand, can happen days, weeks, years, or decades after your initial surgery. It may be necessary if you’re getting radiation therapy or have other complications. And even if you were counseled against getting reconstruction some time ago, it may be possible now due to improvements in technology. 

Self-care after your mastectomy

As we mentioned above, you’ll work closely with your healthcare team to care for yourself after the procedure. Here are a few things to ask about:
  • Pain management: You may be given a prescription medicine to deal with pain around the surgery area.
  • Signs of infection & lymphedema: The team will tell you what to watch for (e.g. redness, swelling, tenderness) and when to contact them.
  • Wardrobe choices: You may not be able to wear a bra or prosthetics until your body heals. Your team will help you know when it’s time.
  • Movement & exercise: You’ll have to make some adjustments to the way you use your chest and arms. Your team will also suggest certain exercises that will keep your muscles from getting stiff.
  • Drain care: After the procedure, you may have a surgical drain implanted in your chest or armpit for 1-2 weeks. This keeps the area free of fluid so it can heal. Your healthcare team will show you how to empty and clean the drain.

The content on this website is intended to provide the best possible information for you, but should not be considered—or used as a substitute for—medical advice. If you have questions about your diagnosis or treatment, please contact your health care provider(s). For questions or comments about this content, please email us at support@jasperhealth.com.