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.
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.
UW Medicine breast surgeons do surgery for Fred Hutch patients at UW Medical Center – Montlake and 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.
For patients who want it, our breast reconstructive surgeons, who are also from UW Medicine, offer many 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.
Our team at the Fred Hutch Breast Health Clinic specializes in helping you prepare for surgery and recover afterward. We are here to understand your needs and help you heal.
The goal of a lumpectomy 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 have two methods to choose from:
- SAVI SCOUT® surgical guidance — Before your surgery, a breast radiologist will use ultrasound or mammogram to see where your tumor is. 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.
- Wire localization — On the morning of your surgery, a breast radiologist will use mammography or ultrasound to see where your cancer is. 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.
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 need 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.
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.
This means your surgeon will remove all your breast tissue. This is also called a total mastectomy. This type of mastectomy provides an aesthetic flat closure. They also remove your nipple and the first lymph nodes where your cancer might have spread (sentinel nodes).
You might have a total mastectomy if you do not want reconstruction the same day or if you cannot have it the same day for health reasons.
For this option, your cancer surgeon will make an incision (cut) around your nipple and areola (the darker skin around your nipple). They will remove the nipple and areola. They will also remove your breast tissue through this small opening. During the same operation, your reconstructive surgeon will use the small opening to reconstruct the breast. They will put in tissue from your abdomen, or they will put in a tissue expander (a temporary inflatable implant that makes space for a future implant).
This may be right for you if your cancer does not involve your skin and you want breast reconstruction right away.
This surgery involves making an incision (cut) under the fold of your breast or a vertical incision below the nipple. Your nipple and areola will stay intact. This is an option for many patients with cancer that does not involve the nipple or areola. Like a skin-sparing mastectomy, a nipple-sparing mastectomy is combined with immediate breast reconstruction.
This type of surgery is also an option if you are having a preventive mastectomy. Some people choose this because they have genetic changes or a family history that raises their breast cancer risk.
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.
The fewer lymph nodes that are removed, the lower your risk of side effects. (Side effects can include nerve problems or lymphedema, which means swelling in the arm.) This is why we do sentinel lymph node biopsy whenever possible rather than automatically removing more nodes.
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 is a type of swelling that can happen after surgery or radiation therapy that affects lymph flow. Our breast and reconstructive surgeons offer advanced ways to prevent or 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. We 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.