Breast surgery

This is a service providing surgical treatment for cancer of the breast and reconstructive surgery of the breast.

Surgery is one of the main treatments for breast cancer. The type of surgery you have depends on the stage of the cancer and your own preferences.

Your surgeon usually tries to keep as much of the breast as possible (breast-conserving surgery), although you may need to have the whole breast removed (mastectomy). You may be asked to decide which operation you have.

During the operation, your surgeon may remove some or all of the lymph nodes in your armpit to check them for cancer cells. There are different types of lymph node surgery.

If you are having a mastectomy, your surgeon will ask if you want a new breast shape to be made at the same time. This is called breast reconstruction. You may choose not to have this, or may want to wait until you’ve finished other cancer treatments.

Breast surgery procedures

Wide local excision

A wide local excision is sometimes referred to as a lumpectomy.

This is an operation to remove either a cancer or a pre-cancerous area (which is surrounded by a margin of healthy tissue) from your breast.

Usually, the operation also includes removing some of the lymph glands from your armpit (axilla).

Mastectomy

A mastectomy is an operation that involves removing all of your breast, including your nipple.

It usually includes removal of some of the lymph glands from the armpit (axilla).

A mastectomy leaves a horizontal scar across your chest - from under your arm, to just before your breastbone.

Removal of lymph nodes

Lymph nodes from the armpit (axilla) are commonly removed in treating breast cancer.

The main reasons for this are:

The presence or absence of cancer cells in lymph nodes is used to determine any additional treatment which may be necessary for breast cancer; such as drug therapy or radiotherapy.
If cancer cells are present within the lymph nodes, they can grow there and cause problems in the armpit. Possible problems include pain, obstruction of blood vessels and swelling of the arm (lymphoedema), on the affected side. Removal of affected lymph nodes can help to prevent this.

Breast reconstruction

Breast reconstruction is the creation of a new breast shape using surgery.

Breast reconstruction may take place after removal of a whole breast (mastectomy) or part of the breast (breast-conserving surgery).

You can have reconstruction at the same time as breast cancer surgery (immediate reconstruction), or months or even years later (delayed reconstruction). Breast reconstruction often involves several operations to give you the best outcome possible.

There are usually different options available for breast reconstruction and your breast surgeon will explain which one is most suitable for you.

The new breast shape can be created using an implant and/or your own tissue from another part of the body, usually the back or lower abdomen (belly). Reconstructed breasts don’t usually have a nipple but one can be created with surgery and tattooing at a later date. Prosthetic stick-on nipples can also be used.

The aim of breast reconstruction is to create a breast shape that looks as natural as possible and to try to match the breast on your other side in size, shape and position.

However, even with the best possible outcome, there will be differences between the remaining breast and the reconstructed one, and sometimes surgery on the other side can help. This can be done at the same time as the reconstruction, but waiting for the reconstruction to heal and settle into position may be better. Your specialist team will give you an idea of how long this is likely to be.

There are usually different options available for breast reconstruction and your breast surgeon and breast care nurse will explain which one is likely to suit you best. It’s helpful if you can take some time to consider these options without feeling under pressure to make a decision. You may need a couple of discussions with your specialist team before you feel confident deciding what to do.