Breast Cancer Surgery: Understanding the Options
This Breast Cancer Awareness Month, we at Cirdan want to take a moment to celebrate the strength and resilience of everyone navigating the breast cancer journey – patients, survivors, families, and care teams alike.
It is a time to come together, raise awareness, and continue conversations that empower people through knowledge, compassion, and support.
Each breast cancer journey is different, and every decision along the way is deeply personal. From understanding a diagnosis to exploring treatment options, having clear information and supportive guidance can make an enormous difference.
One of the most significant parts of this journey is often surgery. While the thought of surgery can feel daunting, today’s advances mean there are more personalised options than ever before. The right approach depends on each person’s unique situation, their health, and their preferences, with care teams working closely to find the path that feels right for the patient.
In this piece, we will explore the different types of breast cancer surgeries and how each option can support healing, as part of the wider journey toward recovery.
Breast-Conserving Surgery (Lumpectomy)
The aim of this surgery is to remove the cancer while keeping as much of the natural breast as possible.
The surgeon removes the cancerous lump along with a small, protective border of healthy tissue around it. This helps ensure no cancer cells are left behind. Most of the time, this surgery is followed by a course of radiotherapy to treat the rest of the breast tissue and lower the risk of the cancer returning.
A lumpectomy (or wide local excision) is a very common choice for people with early-stage breast cancer, especially for those who wish to maintain the familiar look and feel of their breast.
Mastectomy
Sometimes, the safest and most effective path forward is to remove the entire breast. This is called a mastectomy. A surgeon might recommend this if the area of cancer is large, if there are cancerous cells in different areas, or if breast-conserving surgery isn’t a suitable option for that individual.
Even within a mastectomy, there are different approaches designed to meet a patient’s needs:
- Simple (total) mastectomy – This removes all of the breast tissue.
- Skin-sparing or nipple-sparing mastectomy – Breast tissue is removed but much of the skin (and sometimes the nipple) is preserved, often for reconstruction.
- Modified radical mastectomy – This involves removing the breast tissue as well as most of the lymph nodes under the arm.
- Contralateral prophylactic mastectomy – This is a personal and preventative choice to remove the healthy, unaffected breast to lower the future risk of a new cancer developing, often considered by people with a high-risk genetic mutation.
In the UK, about 60% of people have breast-conserving surgery, while around 40% have a mastectomy.
Lymph Node Surgery
The lymph nodes in the armpit are often the first place breast cancer cells might travel. Checking them helps doctors understand the cancer better and plan any further treatment.
- Sentinel Lymph Node Biopsy (SLNB): This is a very targeted procedure. The surgeon identifies and removes just the first one or two nodes that drain fluid from the breast. If these nodes are clear of cancer, it is very unlikely that others are affected, and no more surgery is needed there.
- Axillary Lymph Node Dissection: If cancer is found in the sentinel nodes, the surgeon may need to remove more lymph nodes from the armpit to be certain all the cancer is gone. This does carry a higher risk of side effects like arm swelling (lymphoedema), so the care team will be there to support the patient with managing this.
A Patient’s Choice: Reconstruction and Going Flat
After surgery, the path forward is deeply personal. The patient’s feelings, values, and comfort matter most, and there is no single “right” choice. The focus is on what feels best for the individual, whether that’s reconstructing the breast, choosing a different surgical approach, or opting to go flat.
- Oncoplastic Surgery: This approach combines cancer removal surgery with plastic surgery techniques. It allows for larger tumours to be removed while reshaping the remaining breast tissue to achieve the best possible cosmetic result.
- Breast Reconstruction: For those who have a mastectomy, they can choose to have the breast shape restored. This can be done at the same time as the mastectomy or at a later date. Reconstruction can be done using breast implants or by using a person’s own tissue from another part of their body.
- Choosing to Go Flat: Many people choose not to have reconstruction. Opting for a flat closure is a positive and empowering choice for many.
Navigating the Journey with Confidence
Every breast cancer journey is unique. For each individual, surgery may mean conserving the breast, having a mastectomy, choosing reconstruction, or deciding not to reconstruct. Understanding the options helps people feel more in control and better able to make choices that align with their life, body, and values.
Above all, it is important for anyone on this journey to know that they are not alone. Asking questions, seeking support, and taking the time to weigh all the options are vital steps that help a person navigate this path with confidence and care.