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Nearly everyone with non-metastatic breast cancer has their tumor removed. For metastatic breast cancer, surgery is sometimes done to help relieve symptoms.
Breast surgery is very personal, and we want to help you make decisions you feel comfortable with. We will take the time to talk with you about your options, what to expect and any questions you have.
Breast Cancer Care Tailored to You
You and your family are our top priority. At Fred Hutch Cancer Center, we offer comprehensive and compassionate care — personalized to you. You'll have access to the latest treatment options, clinical trials and supportive care services.
Types of Surgery to Treat Breast Cancer
At Fred Hutch Cancer Center and UW Medicine, our experienced surgeons offer many types of breast cancer surgeries, including reconstructive surgery if you want it.
You may be able to have surgery to remove your cancer and keep your healthy breast tissue (lumpectomy), or you may need surgery to remove the entire breast, including the cancer (mastectomy). This will depend mainly on the size of the cancer, where it is and if you have one tumor or several tumors in the breast.
If you have metastatic disease, meaning the cancer has spread to other places in your body, your cancer cannot be fully removed by surgery. So your care team will probably not recommend this form of treatment. However, we may suggest surgery to help with symptoms.
Lumpectomy
The goal of a lumpectomy (breast-conserving surgery) is to remove all your tumor while leaving as much healthy breast tissue as possible.
If your tumor is larger compared to your breast but you do not need a mastectomy, you may have another option. It is called oncoplastic surgery. In this approach, a breast surgeon takes out the cancer, and in the same operation, a reconstructive surgeon reshapes the breast. Sometimes they reshape the other breast too, reducing or lifting it to even out the breasts.
Sometimes, cancer does not make a lump that surgeons can feel. In this case, they need help to locate and remove exactly the right tissue. At Fred Hutch, we use various methods to guide surgical removal of a cancer that can’t be felt. These include:
- SAVI SCOUT surgical guidance — Before your surgery, a breast radiologist uses ultrasound or a mammogram to locate your tumor. They will put a tiny radar-reflecting chip (SAVI SCOUT) into the tumor through a needle. During surgery, your surgeon will scan your breast with a small wand that sends out a radar signal. The signal bounces back from the chip, showing your surgeon which tissue to remove.
- EnVisio surgical navigation system with SmartClip – Before your surgery, a breast radiologist uses ultrasound or a mammogram to locate your tumor. The radiologist inserts a tiny radio-frequency identification, or RFID, chip (EnVisio SmartClip) into the tumor through a needle. During surgery, your surgeon scans your breast with a small wand that locates the RFID chip and identifies the tissue to remove.
- Wire localization — On the morning of your surgery, a breast radiologist will use mammography or ultrasound to locate your tumor. They will insert a thin guide wire into your breast to mark the cancer. During surgery, the wire will show your surgeon which tissue to remove.
Mastectomy
If a lumpectomy is not an option for you, you might have a mastectomy. Also, some patients who could have a lumpectomy choose to have a mastectomy instead. A mastectomy is when all breast tissue is removed.
You might have a mastectomy if:
- You have certain types of cancer, like inflammatory breast cancer.
- Your cancer has advanced and is large compared to your breast size.
- You already had a lumpectomy and radiation of your breast.
- You choose to have mastectomy rather than lumpectomy.
There are many ways to do the surgery. Your surgeon will talk with you about the options, what you prefer and what we recommend for you. Whatever you choose, we will take care to remove your cancer and still get you the best cosmetic results.
Sentinel Lymph Node Biopsy
The sentinel lymph nodes are the first lymph nodes in the armpit that breast cancer would spread to. Typically, surgeons remove these nodes for testing to check if breast cancer has spread there.
This information can guide the medical oncologist and radiation oncologist about what other therapies might be needed to treat your cancer. Depending on your age and the stage (size) and type of your breast cancer, you may not need to have any sentinel nodes removed.
If the sentinel lymph nodes are cancer-free, you do not need to have any more taken out. If the sentinel lymph nodes have cancer, you may or may not need to have more taken out.
Lymphedema
Lymphedema is a condition where a part of or the whole arm can develop chronic swelling after surgery or radiation therapy due to disrupted lymph flow. Our breast and reconstructive surgeons offer advanced ways to prevent and treat this condition. Preventive techniques include axillary reverse mapping (ARM) and microsurgery to restore lymph flow (known as LYMPHA), which is done at the same time as lymph nodes are removed. UW Medicine reconstructive surgeons also offer surgery to treat lymphedema after it starts, such as lymphovenous bypass (also called lymphaticovenular anastomosis, or LVA) and microsurgical transfer of lymph nodes to the affected area (vascularized lymph node transfer, or VLNT). At Fred Hutch, we also have physical therapists who know how to prevent, detect and treat lymphedema.
Breast Reconstruction
For patients who want it, our breast reconstructive surgeons offer many reconstruction options. These include same-day reconstruction, which means that reconstruction can be done at the same time as the cancer is removed. Some people decide they do not want reconstruction (also known as “going flat” or aesthetic flat closure). We support whatever you choose.
Why Choose Fred Hutch for Breast Cancer Surgery
As a patient at Fred Hutch, you’ll have surgery done by UW Medicine breast surgeons at UW Medical Center – Montlake or UW Medical Center – Northwest. All of our surgeons are fellowship-trained in breast surgery/surgical oncology, which means that they are physicians who have done extra training to specialize in cancer surgery.
Your first step will be to meet with your breast surgeon. They will carefully look at your imaging, biopsy results and health needs. They will tell you about your surgery options and explain what we recommend for you and why.
Our team at the Fred Hutch Breast Health Program specializes in helping you prepare for surgery and recover afterward. We are here to understand your needs and help you heal.
Our surgeons try to spare any nerves we can that supply the skin of the breast (otherwise known as nerve-sparing or sensation-sparing mastectomy). However, even in doing so, many women report permanent sensation loss and/or numbness, most often to the central part of the breast.
- Lumpectomy: Most people will need radiation therapy after healing from their surgery. You may also need chemotherapy, hormone therapy or targeted therapy before or after surgery.
- Mastectomy: You may need chemotherapy, hormone therapy or targeted therapy before or after surgery.
You may need surgery after a lumpectomy or mastectomy.
- Lumpectomy: You may need surgery to make sure all of the cancer is removed if there are cancer cells at the edge of the removed breast tissue.
- Mastectomy: If you have reconstructive surgery, you will likely need more than one surgery for reconstruction.
Pain is a common side effect after surgery for breast cancer. Your Fred Hutch care team will give you instructions to help prepare for your surgery and support you after your surgery, including regional nerve blocks done in surgery to help prevent and lessen pain with your recovery.