The first treatment for breast cancer is usually surgery. The aim of surgery is to remove all the cancer. The type of surgery depends on factors such as the size of your cancer, the size of your breast, the position of the cancer in your breast and what you want.
Surgery may involve removing the cancer and a rim of breast tissue around it (wide local excision) or removing the whole breast (mastectomy).
At the same time, some of the lymph glands in your armpit (the axillary lymph nodes) are removed. A pathologist will examine these lymph glands to see whether you need further treatment after your surgery.
Mastectomy is the removal of your whole breast, including some of the skin and the nipple. Your chest muscles are not removed.
Usually, the lymph nodes in your armpit are removed through the same cut (incision) during this operation (called axillary node clearance or dissection).
Mastectomy performed today is less disfiguring than the radical mastectomy of the past. It is carried out in a way that makes it easier for your breast to be reconstructed. After a mastectomy, most women will have a horizontal scar across their chest.
Breast reconstruction can be performed at the same time as a mastectomy (immediate reconstruction) or after all your treatments for cancer are completed, as a separate operation (delayed reconstruction).
For many women, it is now possible to have a smaller operation, such as a partial mastectomy (or wide local excision). A breast-conserving operation involves removing the breast lump with some surrounding normal breast tissue to ensure a good clearance.
Surgery is then followed by radiation treatment to the remaining part of the breast. This usually happens 6–8 weeks after surgery. This makes sure any cancer cells that are still present in your breast are treated, and significantly reduces the risk of cancer recurring in the remaining breast tissue.
Lymph glands are also removed for examination in these smaller operations. This is often done through a separate incision (cut) in your armpit.
Breast-conserving operations have been routinely performed for many years. Studies show that both mastectomy and breast-conserving operations with radiation treatment are equally effective in the treatment of early breast cancer.
However, breast-conserving surgery is not suitable for every woman with breast cancer.
Advantages and disadvantages of surgical methods
While many women may want a breast-conserving operation, whether this is possible depends on the size of the breast cancer and the size of your breast.
It is helpful to weigh up the advantages and disadvantages of each method for yourself.
Radiation treatment may not be needed.
In some cases, if the tumour is large, close to the underlying muscle or if there are many lymph nodes involved, radiation treatment is still recommended to reduce the risk of cancer recurring.
For some people, mastectomy and reconstruction will give a better cosmetic result than breast-conserving surgery.
The whole breast is removed (though reconstruction is possible).
Only the area of the cancer is removed.
Some operations may require a large amount of breast tissue and cancer to be removed, and the remaining tissue may not heal into the shape of a normal breast. How the breast looks after surgery is referred to as the ‘cosmetic result’.
Side effects of breast surgery
You may experience some of the following:
- Wound infection where the wound may feel tender, swollen and warm to touch. There may be redness in the area and/or discharge from the wound. You may feel unwell with fever. If this happens, you need to see your healthcare provider as soon as possible.
- Bruising and haematoma is when blood collects within the tissues surrounding the wound causing swelling, discomfort and hardness. Your body will reabsorb the blood within a few weeks.
- Pain in your armpit or down your arm is more likely if you have lymph glands removed. You will get advice about exercises to reduce the pain and improve your arm movement after surgery.
- Cording is a pain like a tight cord running from your armpit, down your upper arm and through to the back of your hand. Cording is thought to be due to hardening of your lymph vessels. Cording may restrict movement and continue for many months. Physiotherapy and exercise may help.
- Reduced sensitivity of the inner side of your upper arm may occur. It may be a sign of nerve damage which would have been discussed with you before your surgery. It's usually temporary and improves or disappears about 3 months after surgery.
- Swelling caused by fluid build-up (seroma) which may need to be drained for days, and in some cases, several weeks. A nurse will tend to your drain and bandages.
- Swelling of your arm (lymphoedema) may occur after lymph glands have been removed from your armpit. On rare occasions, this swelling can extend into the chest wall.
- Reduced range of movement in your shoulder may happen. You'll be given an exercise programme to improve this after surgery, and sometimes a physiotherapist will help you.
It’s a good idea to discuss possible side effects with your doctor before your operation. Tell your breast care nurse or doctor if you have any of these side effects after your surgery.
After your operation, your surgeon will discuss your tumour with other specialists to decide what further treatment, if any, will be recommended to you. This might include radiation treatment, chemotherapy and/or hormone treatment.
After surgery care
Following your surgery, it may take some time to regain the full use of your arm. Your physiotherapist or breast care nurse will give you instructions for exercises.
You may be concerned that your arm will swell after your lymph glands have been removed. This is much less common today because of the better methods of surgery and radiation treatment. However, a few people still develop problems with arm swelling (called lymphoedema). To reduce the risk of this happening, you should avoid injury or infection to your arm or hand by doing the following:
- Wear gardening gloves when gardening, use an oven glove when handling hot dishes and use a thimble for sewing.
- If you're out in the sun, protect your arm from sunburn by wearing a long-sleeved shirt, and use a good sunscreen (SPF 30+) on uncovered areas.
- Get help with heavy jobs like moving furniture or carrying heavy luggage, and avoid using heavy backpacks for any length of time.
- It may help to wear a support sleeve when flying.
- If it can be avoided, remind health professionals not to take your blood pressure or have blood tests taken from the affected arm.
- Avoid having an intravenous drip in that arm and ask that any injections, including acupuncture or anaesthetics, be given elsewhere.
- If you have a cut, clean it well and use an antiseptic dressing. See your healthcare provider quickly if you think it is infected.
- Be aware of swelling in your arm at any point in the future. Contact your doctor if this occurs.
Lymphoedema therapists and physiotherapists can also advise you about the need to wear a support sleeve if your arm does swell up. Read more about lymphoedema.
Breast forms (prostheses)
If you have had a mastectomy, you may want to consider using a breast form (prosthesis). A breast form can give a good cosmetic appearance as well as helping your balance and posture. Many people choose to use a breast form although some prefer not to.
Breast forms are also available for people who have had lesser surgery (partial mastectomy).
Immediately after surgery, temporary prostheses are available from your local Cancer Society or breast care nurse. About 6 weeks after your operation, you may choose to wear a permanent prosthesis.
You are entitled to a benefit for a permanent breast form. Ask your surgeon or breast care nurse for a medical certificate of entitlement.
Reconstruction of your breast
After a mastectomy, your breast can be reconstructed either straight away or later. A surgeon's decision about which method of reconstruction to recommend is based on many factors.
You should discuss reconstruction fully with your specialist and ask any questions you have before the operation. You may be referred to a plastic (or reconstructive) surgeon.
Many people don't want to have a reconstruction. Speaking with a breast care nurse or with other people who have had breast cancer may be helpful.