Breast Cancer Surgery Options

For women with a new diagnosis of breast cancer, understanding all the surgical options can be overwhelming and stressful.  In this video, we review some of the historical options, as well as the most commonly used surgeries today, ranging from most aggressive to least aggressive.

Read the full video transcript below:

Understanding the difference between different kinds of breast surgery can be incredibly stressful, especially in the wake of a new diagnosis of breast cancer. One strategy that helps me keep all the different options organized in my head is to think of them in terms of the more aggressive options down to the less aggressive options.

When the first breast cancer surgery was done over a hundred years ago, doctors understood that this was a serious disease and it needed to be cured with big surgery. 

For years, the radical mastectomy was the standard of care. With this surgery, surgeons removed not only all of the breast tissue, as well as the nipple and skin, but also the pectoralis muscles and all lymph nodes ranging from the low part of the armpit all the way up to just above the clavicle. But that very aggressive surgery has been paired back in modern times. Now, the pectoralis muscle is left behind, thankfully, and fewer lymph nodes are removed in what's called a modified radical mastectomy.

A smaller surgery yet, the extended simple mastectomy removes not only the breast tissue, skin, and nipple but also only the lymph nodes in the lowest part of the armpit closest to the breast. In a simple mastectomy, only the breast tissue, skin, and nipple are removed; the lymph nodes remain in place.

Now let's shift our focus to the other breast, where in a hypothetical situation, there's a small tumor in the upper outer quadrant of the breast. This situation lends itself well to a partial mastectomy or what's known colloquially as the lumpectomy.

Because the unaffected breast remains intact, we call this approach breast-conserving surgery. With this kind of surgery, the tumor is removed with a margin of normal tissue around it. Sometimes, surgeons can do clever things to hide the scar, especially around the nipple.

For some women with breast cancer, it's safe to do a smaller lymph node surgery.

With sentinel lymph node sampling, a tracer is injected into the tumor and travels to the nearest lymph node. If cancer has spread to lymph nodes, it's most likely to have first traveled to this sentinel lymph node, so it's removed at the time of surgery and examined under a microscope to determine whether or not there are any cancer cells inside.

This is not medical advice. Talk to your doctor before making any medical decisions.