Nearly all women with breast cancer have surgery as part of their cancer treatment.
Surgery for SCCA patients is performed by UW Medicine breast surgeons who are fellowship-trained in breast surgery/surgical oncology. They perform breast surgeries exclusively, and they partner with UW Medicine breast reconstructive surgeons for patients who want reconstruction.
Your first step toward surgery is to meet with your breast surgeon, who will carefully review your imaging and biopsy results, evaluate your health needs, ask about your personal preferences and explain your options, the type of surgery we recommend for you and what to expect.
- If you have ductal carcinoma in situ (DCIS), you may be able to have a lumpectomy, depending on the size of the cancer and whether the surgeon can get cancer-free margins (called negative margins). The margins are important in ensuring that no cancer is left behind. Some women with a large area of DCIS need a mastectomy.
- If you have invasive breast cancer, you may be able to have a lumpectomy, or you may need a mastectomy. The decision depends in part on the size of the tumor compared to the size of your breast and whether the cancer is in more than one segment of your breast.
The goal of a lumpectomy is to remove your tumor completely while leaving as much of your healthy breast tissue as possible — an approach called breast-conserving surgery.
Some women who need a lump removed have surgery called donut mastopexy to remove their tumor with negative margins while preserving the shape and appearance of their breast.
If your cancer doesn’t form a lump that surgeons can feel, they need guidance to locate and remove exactly the right tissue.
At SCCA, we offer SAVI SCOUT Surgical Guidance System.
- Up to 30 days before your surgery, a breast radiologist uses ultrasound or other imaging to locate your tumor and insert a tiny infrared chip into it through a needle.
- During your surgery, your surgeon scans your breast with a small wand that emits a radar signal. The signal bounces back from the chip so your surgeon can precisely locate the tissue you need removed.
If SAVI SCOUT is not the best option for you, your surgeon may pinpoint your cancer using wire localization.
- On the morning of your surgery, a breast radiologist uses mammography or ultrasound to locate your cancer and insert a thin guide wire into your breast to mark the cancer.
- During your surgery, your surgeon uses the guide wire to tell which tissue to remove.
If a lumpectomy is not an option for you or if you would rather have all breast tissue removed to reduce your risk of cancer recurring in your breast, you may have a mastectomy. You might need a mastectomy if:
- You have certain types of breast cancer, such as inflammatory breast cancer.
- Your cancer has advanced and is quite large when it’s diagnosed.
- Your cancer is in more than one-quarter of your breast.
There are several choices for how the surgery can be done. Your surgeon will talk with you about which option they recommend for you and why.
- Total mastectomy — If you don’t want reconstruction at the time of your mastectomy, or if you can’t have reconstruction at the same time for health reasons, your surgeon removes all your breast tissue, your nipple and the first lymph nodes where your cancer might have spread. These nodes are checked for cancer during your surgery. If cancer is present, the surgeon removes more lymph nodes from under your arm.
- Skin-sparing mastectomy — If your cancer does not involve your skin and you want immediate breast reconstruction, your cancer surgeon makes an incision around your nipple and areola (the darker colored skin around your nipple), removes the nipple and areola, and removes your breast tissue through this small opening. Your reconstructive surgeon uses the same opening to insert tissue from your abdomen (DIEP flap) or a temporary expander (replaced later with an implant).
- Nipple-sparing mastectomy — This surgery requires a small incision under the fold of your breast or on the outer side of your breast, leaving the nipple and areola intact. It is an option if you are having a preventive, or prophylactic, mastectomy because you have genetic mutations that put you at high risk for breast cancer or you have a strong family history of breast cancer. It is also an option for many women with small, early-stage cancers that don’t involve the nipple or areola.
Sentinel lymph node biopsy
Your surgeon may remove some lymph nodes under your arm on the same side as your cancer to see if cancer has spread there.
The fewer lymph nodes you have removed, the lower your risk of side effects, such as lymphedema (swelling) in your arm or nerve injury. This is why SCCA performs sentinel lymph node biopsy whenever possible.
Your surgeon locates and removes only the first lymph nodes where your breast cancer might spread (the sentinel, or gatekeeper, nodes).
- If the nodes are cancer-free, you do not need any more removed.
- If the nodes contain cancer, you may need more removed (called axillary lymph node dissection).
Our experienced team of surgeons is led by David R. Byrd, MD, who pioneered sentinel node biopsy in the Pacific Northwest.
Preventing and treating lymphedema
Lymphedema is not common, but it is a possible complication. So after any lymph node surgery, we refer our patients to physical therapists (PTs) with expertise in preventing, detecting and managing lymphedema.
We have several resources for lymphedema treatment, including PTs who provide complete decongestive therapy and specialized reconstructive surgeons who offer advanced surgical treatments, such as lymph vessel reconnection surgery and lymph-node transfer.