Breast Cancer Surgery: Types of Operations and How to Choose the Right One

Breast cancer surgery involves the removal of cancerous tissue from the breast and may include lymph nodes located near the breast. The surgery selected is based on the size and stage of the cancer, the size of the breast, the necessity of other treatment and personal preference. 

Types of breast cancer surgeries include lumpectomy, mastectomy, lymph node surgery and breast reconstruction. Some patients will retain most of their breasts while others will undergo removal of the whole breast. Both types of surgery can be successful depending on the cancer and subsequent treatment.

Learning about various types of surgeries will enable you to have an informed discussion with your surgeon on the advantages, limitations and complications. This blog provides information on various types of operations, breast cancer surgery lumpectomy vs mastectomy, potential complications and factors influencing the choice of surgery.

What Are the Types of Breast Cancer Surgery?

The treatment for breast cancer includes more than just a lump. Depending on the diagnosis, the surgeon might take away either the partial breast or the whole breast, check the lymph nodes, or even reconstruct the breast after the procedure of mastectomy.

The surgeries for treating the condition can be listed as follows.

1. Lumpectomy or Breast-Conserving Surgery

Lumpectomy is the surgical removal of the tumor, together with a surrounding tissue, which is healthy, and saving the rest of the breast.

This surgery is advised when the tumor is not very big compared to the breast and it can be removed from the breast, leaving clear margins.

What to expect:

• The surgeon removes tumour along with some tissue around it.
• The pathologist examines the removed tissue to see if there is any presence of cancer in the margins.
• Radiation therapy is usually prescribed to minimize the risk of recurrence of cancer in the breast after lumpectomy.
• Further surgery may become necessary in case cancer is still present in the margins.

Lumpectomy allows patients to retain most of their natural breast. They might even get to have a shorter recovery period with lumpectomy rather than mastectomy.

For many patients with early-stage breast cancer, lumpectomy followed by appropriate radiation therapy provides survival outcomes comparable to mastectomy.

2. Mastectomy

In a mastectomy, the whole breast where there is cancer is taken out. Depending on the type of operation and the amount of the disease involved, there can be more or less tissue from the surrounding parts including the skin and nipples taken away as well.

Mastectomy may be suggested when the cancer is advanced or occurs in several places of the breast. It may happen when the cancer cannot be taken out using breast conservation methods.

The main types of mastectomy are:

Total or simple mastectomy: The surgeon will take out the breast tissue, usually including the nipple, areola and skin. Lymph node evaluation may be done as a separate procedure or at the same time.

Modified radical mastectomy: The surgeon will take out the breast and will perform an axillary lymph node dissection where the lymph nodes under the armpit will be removed.

Skin-sparing mastectomy: Here the surgeon excises the breast tissue while leaving a lot of the breast skin intact. It allows for breast reconstruction where appropriate.

Nipple-sparing mastectomy: The surgeon excises the breast tissue but leaves the nipple, the areola, and much of the breast skin. This procedure is possible only if clinical examination and the location of the cancer suggest it is the case.

Just performing a mastectomy does not mean that radiation therapy, chemotherapy, hormone therapy, or targeted therapy will not be needed.

3. Oncoplastic Breast Surgery

The oncoplastic surgical technique is a combination of cancer removal and shaping procedures of the breast.

The cancerous tissues are surgically removed with the corresponding margins and then the tissues of the affected breast are shaped accordingly. According to the quantity of removed tissues, the technique may include either the breast itself or may imply balancing of the breasts.

It can be useful for people needing a large lumpectomy but desirous to keep their breasts’ shapes.

However, this technique cannot be used for each type of tumour. The oncologist takes into account its position, size, breast size, amount of necessary tissue removal and reconstruction possibilities.

4. Lymph Node Surgery

Breast cancer may metastasize to lymph nodes, especially those located under the arm. Lymph node assessment can help the physician evaluate the extent of the cancer and decide on the next course of action.

There are two procedures utilized.

Sentinel lymph node biopsy: The surgeon removes several lymph nodes that will be the first ones to receive cancer cells. The removed nodes are then checked for cancer cells. This procedure reduces the unnecessary removal of healthy lymph nodes in appropriate cases.

Axillary lymph node dissection: The surgeon removes several lymph nodes under the arm. It is needed when the extent of the spread of cancer, along with other clinical features, necessitates it.

Each patient does not require the same lymph node procedure. Sentinel lymph node biopsy is a less invasive procedure and has a lower risk of arm swelling compared to axillary lymph node dissection.

5. Breast Reconstruction Surgery

Breast reconstruction restores the breast’s shape after mastectomy. Patients may choose reconstruction during the mastectomy or at a later stage.

The main options include:

• Implant-based reconstruction: The surgeon uses a breast implant to recreate the breast’s shape.
• Flap reconstruction: Tissue from another part of the body, such as the abdomen or back, is used to reconstruct the breast.
• Delayed reconstruction: Reconstruction takes place after the initial cancer treatment or recovery period.

Reconstruction is a personal choice, not a requirement. Some patients prefer to use an external breast prosthesis, while others choose to remain flat after surgery.

Your surgical team can explain how reconstruction may affect recovery and whether additional cancer treatment could influence its timing.

Breast Cancer Surgery: Lumpectomy vs Mastectomy

Choosing between lumpectomy and mastectomy is one of the most important decisions many patients face. The difference is straightforward: lumpectomy removes the cancer and some surrounding tissue, while mastectomy removes the entire breast.

When the eligibility criteria are met, for women with breast cancer in its early stages, having lumpectomy with subsequent radiation therapy can produce the same chances of survival as mastectomy surgery.

Factor	Lumpectomy	Mastectomy
Tissue removed	Cancer and surrounding tissue	Entire breast
Breast preservation	Preserves most of the breast	Removes the breast
Radiation therapy	Generally recommended	May or may not be needed
Recovery	Often shorter, depending on treatment	May take longer, especially with reconstruction
Further surgery	May be needed if margins contain cancer	Depends on pathology and reconstruction
Main consideration	Preserving the breast while removing the cancer	Appropriate when breast conservation is unsuitable or not preferred

When Is Lumpectomy a Suitable Choice?

Lumpectomy can be used where the cancerous tumor can be totally removed without removing much of the breast and leaving the breast shape intact. It is generally considered when the cancer is limited to an area that can be treated with breast-conserving surgery.  

Radiation therapy is often recommended after a lumpectomy to reduce the risk of cancer returning and must be possible when indicated. This option may be preferred by patients who wish to preserve most of their breast rather than undergo complete breast removal.

The suitability of lumpectomy depends on the complete clinical picture. Some patients with more than one area of cancer may still qualify for breast-conserving treatment, while others may need mastectomy.

When Is Mastectomy a Better Option?

Mastectomy can be advised in cases where the cancer is extensive compared with the size of the breast or affects multiple areas that cannot be treated effectively with breast-conserving surgery.

The other instance in which a patient may have to undergo mastectomy is when the surgeon is not able to get clean margins. Clean margins refer to a condition where there are no cancer cells left in the margins even after further surgery.

Some patients may choose mastectomy to avoid radiation therapy. Patients with certain high-risk genetic findings may also consider mastectomy to help manage their cancer risk. In some situations, patients may choose this procedure after discussing the benefits, risks and alternatives with their surgeon.

Patients can opt for mastectomy since sometimes they may wish to avoid radiation therapy. But again, mastectomy will not guarantee absence of the disease at all times. Depending on the cancer’s features and risk of recurrence, radiation therapy may still be recommended after surgery. 

It is important that this procedure is decided on consultation with an oncologic surgeon through imaging, biopsies, tumor nature and objectives of the treatment.

How Do Doctors Decide Which Breast Cancer Surgery Is Right?

It is not a one size fits all approach at all. A surgical oncologist evaluates the cancer and the patient’s overall health before recommending a procedure.

Several factors listed below influence this decision.

Cancer size and location: A small tumour in one area may be suitable for lumpectomy. A more extensive cancer may require mastectomy.

Cancer stage and spread: Doctors assess whether the cancer is confined to the breast or has spread to nearby lymph nodes or other areas. This affects the treatment plan and the extent of surgery.

Tumour biology: Hormone receptor status, HER2 status and other pathology findings help determine whether chemotherapy, hormone therapy, targeted therapy or other treatments may be needed before or after surgery.

Breast size and expected appearance: The amount of tissue that must be removed in relation to the breast’s size can influence whether breast-conserving surgery will achieve a suitable result.

Radiation therapy: Lumpectomy is generally followed by radiation. Previous radiation treatment, pregnancy and other clinical considerations may affect the available options.

Genetic risk and family history: Certain inherited gene changes, including BRCA1 and BRCA2 mutations, can affect discussions about removing one or both breasts.

Personal preferences and overall health: Patients should consider their priorities, recovery needs, willingness to undergo additional treatment and views on reconstruction. Other health conditions may also affect surgical planning.

Your surgeon should explain which procedures are medically appropriate, what each involves and why one option may be preferred over another.

What Are the Risks of Breast Cancer Surgery?

Breast cancer surgery risks depend on the type of operation, the extent of tissue removal, the patient’s health and whether reconstruction or lymph node surgery is performed.

Most patients recover without major complications, but every operation carries some risk.

Common and Possible Complications

Pain and discomfort: Pain and discomfort at the site of the surgical procedure is quite common while recovering. It will depend on the type of surgery performed.

Bleeding and infection: Hemorrhage, infections at the wound site, and formation of seromas, which is an accumulation of fluid in the wound tissue, may be experienced post-surgery.

Delayed wound healing: Wound healing problems are common among some people who have underlying diseases that affect the healing process.

Changes in breast appearance or sensation: A lumpectomy can lead to dimpling of the breast and alteration of its shape. A mastectomy procedure leads to alterations in the appearance and feeling of the chest area.

Lymphoedema: Lymph drainage is hampered by the removal of lymph nodes found in the underarm region, resulting in swelling of the arm or hand.

Persistent pain or numbness: Some patients complain of persistent pain, altered sensation or tightness of the chest, shoulder or arm area.

Reconstruction-related complications: Patients undergoing reconstruction may experience implant problems, wound healing issues, infection or complications involving transplanted tissue.

How Can You Reduce the Risk of Complications?

You can support recovery by following your surgeon’s instructions and attending scheduled follow-up visits.

Ensure you take your medication as directed. Keep the surgical wound clean and dress it as per the advice of your healthcare team for better healing. Start exercising your arm and shoulder as soon as your healthcare team permits you. 

Avoid any form of strenuous activity and lifting heavy weights until your surgeon clears you to do so. In case of an increase in the redness of the wound, fever, increased pain, discharge or swelling, contact your healthcare team immediately.

Seek urgent medical attention for severe breathing difficulty, chest pain or heavy bleeding.

Discuss your individual breast cancer surgery risks before the procedure. Your surgeon can explain which complications are relevant to your operation and how the team will monitor and manage them.

What Is Recovery Like After Breast Cancer Surgery?

This is determined by the procedure itself, overall patient’s condition and necessity of further treatment.

Many patients can leave the hospital either on the same day or just after short-term admission there. The more complicated operations (lymph node surgery or breast reconstruction), the longer hospitalization may be.

Lumpectomy allows patients to recover from their normal activities quite fast. While mastectomy can demand a little more time, especially when there are drainage tubes or breast reconstruction.

During recovery, the patient may have issues such as pain, fatigue, limited movement, and changes in sensation. However, all of these should gradually get better as the healing process proceeds. 

Your care team will provide information concerning wound care, pain management, exercise, returning to work, and further visits. In addition, the final pathology report will determine any additional surgeries or treatments.

It should be noted that removal of the cancer is only one step in the treatment process. Based on the results, your care team may also recommend radiation therapy, chemotherapy, hormone therapy, or targeted therapy.

Questions to Ask Your Breast Cancer Surgeon

A clear discussion before surgery can help you make an informed decision. Consider asking:

1. Am I eligible for lumpectomy, mastectomy or both?
2. Will I need radiation therapy or other treatment after surgery?
3. Will lymph node surgery be necessary?
4. What are the likely effects on my breast shape, sensation and arm movement?
5. What breast cancer surgery risks apply to my case?
6. How long should I expect recovery to take?
7. Is breast reconstruction suitable for me, and when can it be performed?
8. Could I need another operation after the pathology results?

If you remain uncertain, you can ask for a second opinion before proceeding. Your surgeon can help you understand the benefits and limitations of each medically appropriate option.

Breast Cancer Surgery at Harmony Hospital

If you are looking for cancer surgery in Ahmedabad, Harmony Hospital offers patient-focused care to help you understand your treatment options and make informed decisions with your medical team. 

The right surgery depends on the type and stage of breast cancer. Our team of doctors may recommend breast-conserving surgery, mastectomy, lymph node removal or breast reconstruction. You may also need other treatments. It all depends on your case and overall health condition.

Ask your doctor about your options, possible risks and recovery. This will help you and your family make informed decisions. We are happy to answer as many questions you may have about your treatment. 

If you or a loved one has breast cancer, consult a qualified surgical oncologist. Early assessment can help you understand your options and plan the next steps.

Conclusion

A breast cancer diagnosis can bring difficult decisions, but you do not have to make them all at once. Firstly, you should learn more about your diagnosis, find out how each of the proposed treatment options will affect your daily life and discuss all the concerns with your surgical oncologist.

Prior to moving ahead, you should be certain of what the operation is meant for, what outcomes you should expect from it and what should happen after the operation. In case of doubt, you may seek a second opinion to make your decision easier.

At Harmony Hospital, our primary objective is to assist patients in making an informed decision regarding their breast cancer treatment. Right decisions are those which meet both your health-related and personal needs.

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