Mastectomy
A mastectomy is surgery to remove 1 or both breasts to treat cancer.
Surgery for Breast Cancer
MSK offers the latest breast cancer treatment options, including surgery. Our breast surgeons are experts in all types of breast cancer surgery. That includes mastectomy, lumpectomy, sentinel lymph node biopsy, and axillary lymph node dissection.
Overview
If you want to learn about surgeries to treat breast cancer, this is a place to start. We’ll explain surgeries such as mastectomy, lumpectomy, lymph node biopsy, and lymph node removal.
For most people with breast cancer, surgery will be part of their treatment plan. Your options may include a mastectomy or a lumpectomy.
At MSK, breast cancer surgery and breast reconstruction often are done during the same procedure. During surgery, your doctor may also do a lymph node biopsy. This procedure lets them take a sample of lymph nodes to inspect for cancer cells.
It can be hard to choose between a lumpectomy or mastectomy. We want to help you make these very personal choices. This information can guide you and get you ready for the choices you and your doctors will make together.
There are a few things that affect which type of surgery is best for you. They include:
- How far the cancer has spread.
- The size of your breasts.
- Your family history and genetic risk.
- Your personal preferences.
Lumpectomy
A lumpectomy removes the tumor and a small amount of breast tissue around it.
Mastectomy
A mastectomy is surgery to remove all your breast tissue to treat cancer. When your surgeons remove 1 breast, it’s called a unilateral mastectomy. If they remove both breasts, it’s called a bilateral mastectomy or a double mastectomy.
This surgery most often includes removing the nipple and the areola (the darker skin around the nipple). In some cases, we can preserve the nipple, areola, or both.
Most surgeries do not harm the chest muscles. But they will remove a small part of the chest muscle only if the cancer is near or touching the muscles.
During your surgery, they may also take out 1 or more lymph nodes from your armpit.
The MSK Difference
We’re experts in diagnosing and treating breast cancer. MSK offers access to the latest research and treatment methods. That’s why our surgeons, doctors, and other experts treat about 3,300 people with breast cancer each year, with the best possible results.
When do you need a mastectomy?
Most people do not need a mastectomy when they have early-stage breast cancer. Your care team will ask you to have a mastectomy only when:
- The cancer is multicentric (MUL-tee-SEN-trik). That means there are cancer cells scattered throughout the breast.
- Too much tissue must be removed during a lumpectomy to preserve most of the breast.
- Radiation therapy is not possible.
There are many kinds of mastectomy options. Our plastic surgeons may also be able to do breast reconstruction during your mastectomy.
These are types of mastectomies:
- Total mastectomy
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This surgery removes the whole breast. That includes the breast tissue, nipple, areola, and most of the skin covering the breast. This surgery is also called a simple mastectomy.
- Modified radical mastectomy
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This surgery combines a total mastectomy with the removal of axillary (underarm) lymph nodes. You’ll need this surgery if the cancer is locally advanced and involves skin, muscle, or many lymph nodes.
- Skin-sparing mastectomy
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In this mastectomy, we remove all of the tissue inside of the breast. Most of the outside skin stays in place. Your skin serves as an envelope to cover your reconstructed breast. People who have a mastectomy with breast reconstruction most often have this type of surgery.
- Nipple-sparing mastectomy
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Surgeons can sometimes save the nipple and areola. After a skin-sparing mastectomy, your ability to have sensations (feelings) will change. The nipple will not become erect or work the way it did before.
- Prophylactic (preventive) mastectomy
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Prophylactic (PROH-fih-LAK-tik) is a preventive procedure. Your care team may recommend it if you have a high risk of getting breast cancer. This surgery lowers the chances you’ll get breast cancer by removing your breast.
Your risk of getting cancer in the other breast may be low enough that you can avoid this surgery. That’s if you’re at average risk.
At MSK, cancer care is what we do best.
Our breast cancer surgeons are experts in the latest surgery methods. Connect with our Care Advisors to start planning your care.
Common questions about mastectomies
What is mastectomy recovery like?
After a mastectomy with breast reconstruction, you will need 4 to 6 weeks to heal. If you do not have reconstruction, your recovery time is closer to 3 weeks.
As you heal, you may feel a few kinds of sensations in your arm, breast, or chest wall. Examples are tenderness, numbness, and twinges.
After your mastectomy, you may also feel like you still have your breast or nipple. This is called a phantom (FAN-tum) sensation.
These feelings most often come and go. They will happen less often within the first few months after surgery.
Will I need other treatments after a mastectomy?
People often start the process of breast reconstruction surgery at the same time as a mastectomy. This is called immediate reconstruction. But you can have breast reconstruction any time after your mastectomy.
You may need other treatments. That includes radiation, drug therapies such as chemotherapy and targeted therapy, and integrative medicine.
MSK provides excellent cancer care on Long Island and in locations in Westchester County, New Jersey, and New York City. Our Evelyn H. Lauder Breast Center in New York City offers a comfortable setting for breast cancer treatment and support.
Is a preventive mastectomy the only way to lower my chances of getting breast cancer?
No. There are other options.
If you’re still menstruating (getting your period) and have a change (mutation) in the BRCA2 gene:
Surgery to remove your ovaries lowers your risk for breast cancer. It also lowers your risk for ovarian cancer, which is higher for people with BRCA mutations.
Your doctor also may recommend treatment with drugs such as tamoxifen. For some people, the risk for breast cancer may fall by almost half.
MSK offers the RISE program, which monitors people who have a higher risk for breast cancer. Regular screening for breast cancer can catch it early, when it’s easier to treat.
Will I get feeling in my breast back after a mastectomy?
You may feel numbness in the breast’s skin, just under your collarbone to the top of the rib cage.
About 18 to 24 months after surgery, you may get some feeling back. Many people get a lot of feeling back, but it may never be the same as before. Some people do not get feeling back.
This is true for all types of mastectomies, including total mastectomies, skin-sparing, and nipple-sparing mastectomies.
Are lymph nodes removed during a mastectomy?
During a mastectomy, most people have a sentinel lymph node biopsy. This is a procedure that removes 1 or more lymph nodes from the underarm area.
These nodes are called sentinel nodes. They’re the first lymph nodes where cancer cells spread to when they leave the breast.
If there’s cancer in the sentinel nodes, in some cases you may need more surgery. We may need to remove most or all of the lymph nodes in the armpit.
Lumpectomy
What is a lumpectomy?
A lumpectomy is surgery to remove a breast tumor with cancer. This surgery only removes the tumor and a small part of normal tissue around it.
A lumpectomy also is called breast-conserving surgery. Your doctor may also call it a wide local excision, segmental resection, or partial mastectomy.
A lumpectomy lets you keep your breast shape and most often your nipple. Lumpectomies can also help you keep feeling sensation in the breast.
Most people with early-stage breast cancer may choose between a mastectomy and breast-conserving therapy. This is a lumpectomy followed by radiation treatment.
It can be a hard choice to make. You may be worried about the cancer coming back if you choose breast-conserving therapy.
But research shows a lumpectomy is a good choice for people with early-stage cancer. They’re not at a greater risk if they have a lumpectomy instead of a mastectomy.
MSK’s breast cancer surgeons are leaders in developing national guidelines for when to use a lumpectomy.
When is a lumpectomy right for you?
A lumpectomy is most often the right choice for someone just diagnosed with early-stage breast cancer. This can include stage 1 and stage 2 breast cancer, or ductal carcinoma in situ (DCIS).
These are other things that make a lumpectomy the right choice for you:
- The tumor is small compared to the size of the breast.
- The tumor is in 1 area of the breast.
- You can get radiation treatments after a lumpectomy.
If you have larger tumors, we can sometimes use chemotherapy to shrink the tumor first. This is called neoadjuvant (NEE-oh-A-juh-vunt) chemotherapy. Neoadjuvant means a treatment given before the main treatment, most often surgery.
During a lumpectomy, our surgeons may be able to do partial breast reconstruction, also called oncoplastic surgery. This method lets us make the breast look better, without the need for a mastectomy.
Common questions about lumpectomies
What is lumpectomy recovery like?
Recovery from a lumpectomy is not the same for everyone. Healing time after surgery can be from a few days to a week. You may need to take off a week from work to recover after a lumpectomy with a lymph node biopsy.
As you’re healing, you may feel a few kinds of sensations in your breast. Some common examples are tenderness, numbness, and twinges. These feelings often come and go, and will get less over time.
As you keep healing, you may feel scar tissue along your incision site. It will feel hard. This is common and should soften over time.
How will a lumpectomy change how my breast looks?
A lumpectomy often causes very little scarring or changes to the breast.
If the surgery is more complex, there are a few ways to make the breast look better. Options are:
- A breast lift
- Breast reduction surgery
- Tissue rearrangement
- Cosmetic plastic surgery on the other breast to make them look the same
Do I need more treatment after a lumpectomy?
People under age 70 who have a lumpectomy should also have radiation therapy. This treatment kills any breast cancer cells that remain after surgery. It also helps stop the cancer from coming back.
This method is also called breast conservation therapy. It works just as well as a mastectomy to treat early-stage breast cancer.
Many people also are helped by drug therapies such as chemotherapy, targeted therapy, or hormone therapy. These treatments can lower the risk of recurrence (cancer comes back) or metastasizing (spreading).
What is lymph node removal during a lumpectomy?
During a lumpectomy, most people with invasive breast cancer have a sentinel lymph node biopsy. This is a procedure that removes 1 or more lymph nodes from the underarm area.
These nodes are called sentinel nodes. They’re the first lymph nodes where cancer cells spread to when they leave the breast. The lymph node sample is sent to a lab to check for signs of cancer.
People with DCIS who have a lumpectomy do not need to have lymph nodes removed.
What is a re-excision lumpectomy?
A re-excision lumpectomy refers to a second surgery. Some people have it when they have cancer cells in the margins. A margin is the healthy tissue around the tumor removed during a lumpectomy.
Re-excision means the surgeon opens the surgical site again. They remove more of the margin of tissue. The goal is to get a margin that has no cancer. We sometimes call this “clearing the margins.”
What is radioactive seed localization before breast surgery?
Radioactive seed localization is a way to locate cancer that’s too small to see or feel by hand. The breast cancer shows up on a mammogram or ultrasound. But your doctor cannot feel it during a breast exam.
The procedure is done up to a week before your lumpectomy. We place a tiny metal seed, about the size of a small sesame seed, into the breast tissue. This marks where the cancer is.
The seed has a small amount of radiation. During your lumpectomy, your surgeon will use a special tool to find the seed and the tissue with cancer around it. They will remove the seed and the tissue.
Will I need a surgical drain after a lumpectomy?
A surgical drain is a rubber drainage tube. It’s used during surgery to collect extra fluid from the area where the tumor was removed. The drain is connected to a plastic bulb to suction up the fluid.
At MSK, we do not leave in surgical drains after a lumpectomy, or after a lumpectomy with lymph node biopsy.
Podcast
Understanding Surgery to Treat Breast Cancer
Cancer doctor Dr. Diane Reidy-Lagunes talks with breast surgeon Dr. Tracy-Ann Moo about the differences between a lumpectomy and a mastectomy. Research shows some people with early-stage breast cancer may only need a lumpectomy.
Lymph node biopsy
What is a lymph node biopsy?
A lymph node biopsy is often done during your breast cancer surgery. This procedure tells us if cancer has spread past the breast tissue.
Lymph nodes are small, bean-shaped structures. They filter out waste products from your lymphatic system. They trap bacteria, viruses, cancer cells, and other waste products. Your immune system cells then destroy these waste products.
During the biopsy, your surgeon takes tissue samples from 1 or more lymph nodes. These samples are sent to a lab and examined under a microscope to look for cancer cells. Your doctor can tell the stage of cancer and plan your treatment.
In the past, we had no choice but to remove most of the underarm lymph nodes in an operation called axillary dissection.
Today, we commonly perform a procedure that allows a faster recovery time called a sentinel node biopsy.
The lymphatic system in a breast.
What is a sentinel node biopsy?
The sentinel nodes are the first lymph nodes breast cancer cells spread to when they leave the breast.
Your doctor will locate the sentinel lymph node. They’ll put a small amount of blue tracer dye, technetium-99 radiotracer, or both, near the site of the tumor. The dye will travel in your lymphatic fluid to your sentinel lymph node. It will stain your sentinel lymph node blue, make a radiotracer signal, or both.
Now that your surgeon can see the sentinel lymph node, they will make an incision (surgical cut).
What happens if we find cancer?
If there’s cancer in the sentinel nodes, you may need more surgery. We may need to remove most or all of the lymph nodes in the armpit.
Your doctor will talk with you about the next steps.
- If you’ve had a mastectomy and cancer is in the sentinel nodes: If cancer is only in 1 or 2 sentinel nodes and you’ll have radiotherapy, we may not need to remove more lymph nodes. Research shows that removing them will not help treatment. Our breast surgeons follow treatment guidelines based on the latest science and research.
- If you’ve had lumpectomy and radiotherapy: If cancer is only in 1 or 2 sentinel nodes, we may not need to remove the lymph nodes. Research shows removing them will not help treatment. Our breast surgeons follow treatment guidelines based on the latest science and research.
- If there is cancer in 3 or more lymph nodes: In most cases, we may need to remove most or all of the lymph nodes in the armpit. This is called an axillary lymph node dissection. If this is necessary, you may be eligible for a lymphatic reconstructive procedure. Your doctor will talk with you if this is an option. You may be eligible to join a research study, also called a clinical trial, about preventing lymphedema.
When you have questions about treatments or appointment scheduling, someone is always there to answer your call.