Choosing the Right Type of Breast Cancer Surgery — and Why It Matters

For women who had breast cancer surgery decades ago, mastectomy was often the only option. However, that’s no longer the case for many women.

The type of breast cancer surgery that will work best for each patient depends on many factors, including the type of breast cancer and its stage. When breast cancer surgery is necessary, women today have options — and recent research has shown the type of breast cancer surgery chosen can have a significant impact on a woman’s quality of life after surgery.

Mapping Out Your Care Plan

After your diagnosis, your oncologist and other members of your cancer care team will talk with you about the right breast cancer treatment for you. Treatment may include local and systemic therapies. Local therapies, such as surgery and radiation therapy, treat the breast and the surrounding lymph nodes, while systemic therapies, including chemotherapy, immunotherapy and hormone therapy, work throughout the body.

“There is no one-size-fits-all treatment for breast cancer,” says Dr. Tara Grahovac, FACS, a board-certified, fellowship-trained breast surgeon with the Beaufort Memorial Breast Care & Surgery Program. “My job is to explain the risks, benefits, pros and cons of each treatment. Your first consultation with your surgical oncologist is typically very in depth so you fully understand what’s ahead.”

Your team may recommend radiation therapy or a systemic therapy along with surgery.

Read More: Radiation Therapy for Breast Cancer

Understanding the Types of Breast Cancer Surgery

Although each woman’s care plan is unique, surgery is often used to treat:

• Ductal carcinoma in situ breast cancer (DCIS), a type of breast cancer confined to the lining of the breast ducts
• Invasive breast cancer, cancer that began in the breast ducts or glands and spread into the breast tissue

In many cases, women who have DCIS or invasive breast cancer will have the option of a lumpectomy, a type of breast-conserving surgery in which only the tumor and a small amount of surrounding tissue are removed.

After a lumpectomy for DCIS or invasive breast cancer, many women have either whole breast radiation therapy or accelerated partial breast irradiation to ensure all cancerous tissue is eradicated, which lowers the risk of cancer recurrence.

Some women with DCIS or invasive breast cancer need only a lumpectomy (also called a partial mastectomy), but others will require one of the following types of mastectomies:

• A total mastectomy removes the entire breast with a flat skin closure.
• A skin-sparing mastectomy removes the breast but not the skin, allowing for breast reconstruction with a tissue flap or an implant.
• A nipple-sparing mastectomy also preserves the nipple-areola complex.
• A modified radical mastectomy removes the entire breast along with most lymph nodes under the arm.

When breast cancer occurs in only one breast, women generally need only a single (or unilateral) mastectomy, which removes only the breast with cancerous tissue. Some women with cancer in only one breast may have a contralateral prophylactic mastectomy, in which the healthy breast is also removed. This may be due to patient preference or because your surgeon has concerns that the healthy breast may be at high risk for cancer in the future. Women who develop cancer in only one breast are usually at low risk of developing it in the other breast, so this procedure is not always necessary.

During a mastectomy, the breast cancer surgeon may also perform a sentinel lymph node biopsy to determine whether cancer has spread to the lymph nodes. If it has, you may need an axillary lymph node dissection, which is surgery to remove lymph nodes.

Read More: Faith Over Fear: Breast Cancer Survivor Shemikia Brown

Why the Type of Surgery Matters

When you have breast cancer, you naturally want to choose the treatment that will eradicate your cancer and prevent it from coming back. In the past, removing the cancer entirely, often using mastectomy, was thought to be the best path forward.

“While mastectomy is still necessary, or preferred in some cases, we have known for a few decades now that survival rates between breast-conserving surgery (or lumpectomy) and total mastectomy are the same,” Dr. Grahovac says. “Furthermore, survival rates for early-stage breast cancer have improved significantly, so now our considerations focus not only on treating cancer and preventing recurrence, but also what life will look like for women after surgery.”

An April 2022 study published in JAMA found that the type of surgery chosen to treat breast cancer has a major impact on quality of life in the years after surgery. The study was based on a questionnaire called BREAST-Q given to young women who had been diagnosed with breast cancer in stages 0 to II. The study found that women who had breast-conserving surgery reported the highest satisfaction with their breasts and the highest psychosocial and sexual well-being in the years after surgery.

Other research into breast cancer surgery demonstrates that total removal of the breast isn’t always necessary or beneficial. Studies on cancer survival rates also show that women who have breast-conserving surgery live as long as those who have mastectomies.

“There are many factors to consider when determining the best course of treatment,” Dr. Grahovac says. “It’s important that we treat you the right way and not rush into decisions. We want to choose the treatment that will not only address your cancer but also help you live your best life afterward.”

If you’ve been diagnosed with breast cancer, call a breast cancer navigator at Beaufort Memorial who can help guide you through the journey, from diagnosis through recovery.