Breast Cancer Surgery

Memorial Sloan Kettering breast cancer surgeon Alexandra Heerdt prepares for a procedure

If you have breast cancer, are considering a preventive mastectomy, or are helping a loved one learn about breast cancer treatment, you’ve come to the right place. We want to help you make these very personal choices to get the best outcome possible. This information is meant to guide you through your journey and prepare you for the decisions and choices you and your doctors will make together.

For most women, surgery will be part of treatment. Your options may include a lumpectomy (also called breast-conserving surgery), a mastectomy, or a mastectomy with breast reconstruction. The extent of the cancer, the size of your breasts, and your personal preferences will help determine which of these surgeries is the right choice for you.

Learn more about the types of surgery for breast cancer.

Jill's Story
Wall Street veteran Jill overcame breast cancer with a lumpectomy, in which surgeons removed her tumor but kept the rest of her breast intact. Then she had hypofractionated radiation, a specialized therapy at MSK that provides concentrated doses of radiation in fewer treatments.
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What is a lumpectomy?

A lumpectomy, or breast-conserving surgery, removes the cancer (a lump or tumor) and a small rim of healthy breast tissue around it, called the margin. Doctors may refer to this type of surgery as breast-sparing surgery, wide excision, or partial mastectomy. This may be an outpatient surgery, meaning that you don’t have to stay in the hospital overnight unless you have other severe health problems. For most women, a lumpectomy must be followed by radiation to get rid of any remaining cancer cells, lowering the risk that the cancer will return. 

Learn more about lumpectomy. 

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What is a mastectomy?

Mastectomy is the removal of the entire breast to treat cancer. Doctors may remove one breast or both. When both breasts are removed, doctors refer to it as a bilateral mastectomy. This surgery usually includes the removal of the nipple and the areola (the dark skin around the nipple). The chest (pectoral) muscles under the breast are left intact unless the cancer is near or touching the muscles. If that happens, a small area of muscle may be removed. Types of mastectomy include:

  • Total mastectomy. This surgery removes the entire breast, including breast tissue, nipple, areola, and most of the skin covering the breast. This is the most common type of mastectomy. It’s also called a simple mastectomy.
  • Modified radical mastectomy. This surgery combines a total mastectomy with the removal of underarm (axillary) lymph nodes.
  • Skin-sparing mastectomy. In this kind of mastectomy, all of the tissue inside of the breast is removed, but doctors are able to keep most of the outside skin intact. Your skin will be used to create a kind of envelope to cover your reconstructed breast. Surgeons do not save the nipple or areola for a number of reasons, including if the cancer involves the nipple. Women who have a mastectomy with breast reconstruction usually have this type of surgery.
  • Nipple-sparing mastectomy. It’s sometimes possible for surgeons to save the nipple and areola during a skin-sparing mastectomy. 

Learn more about mastectomy.

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Lumpectomy or mastectomy — which is right for me?

With early-stage breast cancer, you may be offered a choice between a mastectomy or a lumpectomy followed by radiation therapy. In some women whose cancer cells are scattered throughout the breast or who can’t receive radiation, a mastectomy is medically necessary even though the cancer is early and favorable. While many women opt for lumpectomy, some prefer mastectomy. Discuss the pros and cons of both options with your doctor. It’s helpful to bring a list of the questions and concerns that you’d like to discuss during your appointment to make sure that you get all of the information you need to make the decision that feels best for you. 

If you need help thinking of questions to ask your surgeon, here are a few to get you started.

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Should I have chemotherapy before breast cancer surgery?

Although breast cancer treatment usually starts with surgery, there are some situations in which your doctor may recommend chemotherapy first. For example, if you have a large tumor and small breasts, chemotherapy may shrink the tumor enough to make a lumpectomy possible. Having chemotherapy as the first treatment for breast cancer may destroy cancer in the lymph nodes, which may help some women avoid having their lymph nodes removed. For women with some types of advanced breast cancer such as inflammatory cancer, having chemotherapy as the first step in treatment is standard to be sure all the cancer cells can be removed surgically. In studies involving thousands of women, this has been shown to be just as safe as having surgery first.

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What is a prophylactic mastectomy (preventive mastectomy)?

Some women, on the advice of their doctors, may choose to have their breasts removed as a precautionary measure if they are at a high risk for breast cancer. Prophylactic mastectomy can lower breast cancer risk by at least 95 percent in women with BRCA1 or BRCA2 gene mutations or with a strong family history of breast cancer, according to the National Cancer Institute. If you have a prophylactic mastectomy, you may want to combine it with breast reconstruction surgery. Some women with cancer in one breast choose to have a prophylactic mastectomy of the other breast to reduce the risk of future breast cancers. But for the average woman with breast cancer, the risk of cancer in the other breast is low enough that this is not medically necessary.

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What is breast reconstruction surgery?

You may choose to have breast reconstruction surgery after a mastectomy to rebuild the breast so that it looks similar to the way it did before the surgery. Many times this can be done at the same time as your breast cancer surgery. But it is also possible afterward, even years later. There are many options for reconstruction. After lumpectomy, doctors can enhance the appearance of the breast using fat injections to plump up any dimpled areas where tissue has been removed. They can also perform a breast lift or breast reduction or do plastic surgery on the other breast to create a closely matched pair. After mastectomy, methods of rebuilding the breast include breast implant surgery and using tissue from another part of your body to create a new breast. 

Learn more about breast reconstruction options.

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What is a lymph node biopsy and what is a sentinel node biopsy?

During a lymph node biopsy, a doctor removes lymph nodes to see if cancer cells have spread there. A sentinel node biopsy is the removal of a lymph node or nodes under the arm, called the axillary nodes, which are the first nodes to which cancer cells would travel if they were to leave the breast. This is where the fluid, or lymph, from the tumor flows. If cancer cells are traveling in the lymph system, the sentinel node is more likely than the other lymph nodes to contain them.

This procedure is often done during a mastectomy or lumpectomy. To find the sentinel nodes, a special dye, a low dose of radioactivity, or both are injected into the breast. The nodes containing dye or radioactivity are the sentinel nodes, which are then removed and examined under a microscope. If no cancer is found, no other lymph nodes need to be removed, sparing you a bigger operation. 

Learn more about biopsy procedures.

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What is an axillary lymph node dissection?

An axillary lymph node dissection is when doctors remove most or all of the lymph nodes in the armpit. The procedure may be done if cancer is found in the sentinel nodes. The number of lymph nodes in the armpit varies from person to person but is usually between 15 and 30. In women found to have cancer in their lymph nodes before surgery, giving chemotherapy before surgery is a way to reduce the likelihood of needing an axillary dissection.

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What is recovery like after breast cancer surgery?

Recovery time depends on which surgery you have:

  • After a lumpectomy without a sentinel node biopsy, you’re likely to feel well enough to return to work after two or three days. You can usually resume normal physical activities, like going to the gym, after one week.
  • After a lumpectomy with a sentinel node biopsy, you may need to take up to a week off from work to recover.
  • After a mastectomy without breast reconstruction, recovery takes three to four weeks. Most women experience pain for a few days after surgery, some for longer periods. Feelings of fatigue can last several weeks as your body heals.
  • After mastectomy with breast reconstruction, recovery time can range from four weeks after implant surgery to six to eight weeks for women who have tissue flap reconstruction. 
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What is lymphedema?

Lymphedema is a buildup of fluid in your hand, arm, and, less frequently, breast or chest wall that can cause swelling and sometimes pain. It is more likely to occur if some or all of your underarm (axillary) lymph nodes are removed as part of your cancer surgery, or if these nodes are treated with radiation. Alert your doctor if you have any symptoms of lymphedema, such as arm swelling, redness, or pain. Prompt treatment — which may include compression garments, exercise, and massage — can be extremely helpful. Some patients can also have surgery to improve the lymphatic circulation and decrease symptoms.

Learn more about lymphedema and managing your risk for getting it.

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Why should I choose Memorial Sloan Kettering for breast cancer surgery?

As the world’s largest nonprofit cancer center, we provide leading-edge breast cancer surgery. For many women, we can offer innovative procedures to save or reconstruct the breast. Our full-time staff of breast surgeons has extensive experience and expertise in all types of breast cancer surgery. This gives the 3,300 patients treated through our Breast Cancer Service each year the best possible outcomes. MSK’s breast surgery experts have helped develop national guidelines to help women with breast cancer avoid unnecessary repeat surgeries after lumpectomy while still minimizing the risk that the cancer will return. Our innovative programs help reduce the need for women to have their lymph nodes removed as part of breast cancer surgery. In addition, we closely monitor women who do have lymph nodes removed for signs of lymphedema so that we can treat it early.

Choose MSK for breast cancer surgery because we offer:

  • Compassionate care from a team of experts. More than 80 breast cancer doctors work closely with other specialists, as well as nurse practitioners and other medical professionals, to help our patients get the best results before, during, and after breast cancer surgery.
  • Many of the breast cancer specialists and therapies you need conveniently located at our Evelyn H. Lauder Breast Center in New York City. We also have locations in New Jersey, as well as in suburban New York in Westchester and on Long Island. If you’re traveling from out of town for your care, we’ve negotiated special discounted rates for our patients at nearby hotels.
  • A powerful commitment to patient satisfaction. To continuously improve outcomes and quality of life for our breast cancer patients, MSK developed the Breast-Q satisfaction questionnaire that has now been adopted worldwide.
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What kind of support will I get after breast cancer surgery at MSK?

Our specialists provide comprehensive follow-up care to help you live well after breast cancer treatment. Our services include:

  • A team of experts to oversee all aspects of your recovery, including breast cancer specialists, nurse practitioners, psychologists, and social workers
  • A personalized Survivorship Care Plan with the medical guidance you’ll need to successfully transition to a healthy life after breast cancer treatment
  • Wellness therapies from integrative medicine specialists if you need them to relieve emotional or physical symptoms after surgery or for potential side effects, such as lymphedema
  • Rehabilitation and exercise therapies to help you heal and recover your strength, flexibility, and stamina
  • Emotional support at our Counseling Center
  • Our patient-to-patient support program, which connects you with other breast cancer survivors who understand your challenges and concerns
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