Breast Surgery: What Every Woman Should Know

Knowledge is power in the fight against breast cancer.

Stephanie Ng, MD
Stephanie Ng, MD

It can be unsettling—even overwhelming—to be diagnosed with breast cancer and deal with treatment, which often includes breast surgery. But knowledge can help dispel fears. “It’s useful to know your options and why certain breast surgeries may or may not be done,” says Stephanie Ng, MD, a breast surgeon at Monmouth Medical Center Southern Campus (MMCSC) and a member of the RWJBarnabas Health Medical Group.

Some surgeries remove cancer or tissue, while others restore the breast after cancer is taken out. The procedures you get may be determined by factors such as the nature of your cancer and your medical history. “The more you know, the better you’ll be able to talk with your doctor about which choices are right for you,” Dr. Ng says.

Such conversations often begin with questions like these.

What are the different kinds of breast surgery?

Breast-conserving surgery (BCS) removes only the part of the breast containing cancer and some normal tissue around it but not the breast itself. (These procedures are also called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy.) How much breast is removed depends on a variety of factors, including the tumor’s size and location.

Mastectomy removes the entire breast containing cancer. Various types of mastectomy may remove other tissue near the breast as well, such as lymph nodes. Some women get a double mastectomy in which the surgeon removes both breasts.

How do I know which surgery is best?

If your cancer is in its early stages, you may be able to choose between BCS and mastectomy. BCS allows you to keep most of your breast but often requires treatment with radiation as well. Getting a mastectomy for an early-stage cancer may allow you to skip radiation. Other factors also come into play, including the type of breast cancer, its size and whether you’ve previously been treated with radiation. If you’re a candidate for both BCS or mastectomy after all factors have been considered, it may come down to personal preference, as outcomes for such women tend to be similar with each surgery.

Why remove lymph nodes?

Removing one or more lymph nodes either during surgery to remove breast cancer or as a separate procedure helps doctors determine the cancer’s stage and if the cancer has spread to other parts of the body. In a procedure called sentinel lymph node biopsy, the surgeon removes just one or a few lymph nodes where cancer is most likely to spread first. If no cancer is found, there may be no need to remove more lymph nodes. Keeping lymph node removal to a minimum helps avoid side effects such as arm swelling called lymphedema. If cancer cells are found, more lymph nodes may be removed.

What happens after breast surgery?

Many women can undergo breast reconstruction. After mastectomy, you may be able to have the breast mound rebuilt to restore the breast’s appearance. After breast-sparing surgery, you may be able to have fat grafted onto the breast to minimize any small skin deformations resulting from surgery. Which of multiple reconstructive surgeries you get is determined by your preferences and medical status. Reconstruction may be done at the same time as surgery or later on. Talk to your doctor before surgery about whether to undergo reconstructive surgery and what type of surgery you’d get so the surgical team can plan an optimal course of treatment.

What if surgery won’t help?

If cancer has spread, surgery probably won’t cure your breast cancer. But surgery may still help in certain situations. For instance, surgery may help slow the spread of cancer or help prevent or alleviate certain symptoms. Talk to your doctor about the value of having breast surgery if you have advanced breast cancer. Also, through MMCSC’s partnership with Rutgers Cancer Institute of New Jersey, the state’s only National Cancer Institute-Designated Comprehensive Cancer Center, patients have access to advanced treatment options including clinical trials, many of which are not available elsewhere.

Are You At Risk Of Breast Cancer?

American women have a 1-in-8 chance of developing breast cancer. Will you be one of them? Factors like these can influence risks.

  • Family history: Risks are higher if you have a first-degree relative (mother, sister, daughter or a similarly close male relative) or multiple family members on either side who have had breast cancer.
  • Breast makeup: Dense breasts that contain more connective or glandular tissue than fatty tissue are more likely to develop breast cancer and can make cancer less visible on mammograms.
  • Age: The older you are, the more likely you are to develop breast cancer, especially after age 40, when most breast cancer diagnoses are made.
  • Ethnic background: Breast cancer is often more aggressive in African American women, who also have lower screening rates, so cancers are more often detected at relatively advanced stages. Certain inherited genetic mutations related to breast cancer are also more common in African Americans as well as Ashkenazi Jews.
  • Reproductive history: Having your first menstrual period before 12 or starting menopause after 55 both increase your risk for breast cancer because they increase lifetime exposure to estrogen.

To learn more about breast cancer or make an appointment at the Jacqueline M. Wilentz Breast Center at Monmouth Medical Center Southern Campus, call 732-923-7700.