Nearly all women with breast cancer have surgery as part of their cancer treatment.
Your team at Seattle Cancer Care Alliance (SCCA) is here to provide exceptional surgical care along with the medical and emotional support you need to prepare for your procedure and recover afterward so you can get back to living life.
- Surgery for SCCA patients is performed by UW Medicine breast surgeons, who are all 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.
- We use advanced technologies and the latest surgical techniques to plan and perform your surgery so you get the best possible outcome—such as the SAVI SCOUT surgical guidance system that helps your surgeon precisely target the tissue to remove.
- If you are newly diagnosed with breast cancer, you will see an expert team that includes a breast surgeon and a radiation oncologist and medical oncologist who specialize in breast cancer. They work together to plan and coordinate all your breast cancer care.
- We offer several innovative treatment approaches through clinical trials, such as a study to figure out if radiation therapy is as effective as surgery to treat cancer in lymph nodes under the arm. Radiation therapy carries a lower risk of swelling known as lymphedema.
Your first step toward surgery will be to meet with your breast surgeon, who will:
- Carefully review your imaging and biopsy results.
- Evaluate your health needs, and ask about your personal preferences.
- Explain your options, the type of surgery we recommend for you, why, and what to expect.
- Answer your questions about surgery.
Depending on the size, location, and other features of your cancer, you may have:
- Lumpectomy, in which the surgeon removes only the tumor and a margin of cancer-free tissue around it.
- Mastectomy, meaning the surgeon removes all the breast tissue on the side of the cancer. Your surgeon may also remove lymph nodes under your arm to check whether the cancer has spread.
If You Have Ductal Carcinoma in Situ
Many women with ductal carcinoma in situ (DCIS) can 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
Women who have invasive breast cancer may be able to have a lumpectomy, or they 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.
You may 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.
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. If a quarter (or quadrant) of your breast needs to be removed, you might hear the term quadrantectomy instead of lumpectomy.
Some women who need a lump removed have surgery called donut mastopexy. This is an oncoplastic procedure, meaning it has two goals:
- To remove your tumor with negative margins (the “onco” part)
- To preserve the shape and appearance of your breast (the “plastic” part)
Read more about donut mastopexy on our breast reconstruction page.
SAVI SCOUT Surgical Guidance System
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.
- Up to 30 days before your surgery, a breast radiologist at SCCA uses ultrasound or other imaging to locate your cancer.
- They numb your skin and insert a tiny infrared chip into your tumor through a needle.
- When it’s time for your surgery, your surgeon scans your breast with a small wand that emits a radar signal.
- SAVI SCOUT detects the signal that bounces back from the chip, allowing your surgeon to precisely locate the tissue you need removed.
Pinpointing Cancer with Wire Localization
If SAVI SCOUT is not the best option for you, your surgeon may pinpoint your cancer using a method called wire localization.
- On the morning of your surgery, a breast radiologist at SCCA uses mammography or ultrasound to locate your cancer.
- They numb your skin, insert a thin wire into your breast to mark the cancer, and tape the wire in place.
- Your surgeon uses this guide wire during surgery to tell which tissue to remove.
- The wire is taken out during your surgery.
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.
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.
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 and the nipple (total mastectomy).
- The surgeon also removes the first lymph nodes where your cancer might spread.
- These nodes are checked during your surgery for cancer. If cancer is present, the surgeon removes more of the lymph nodes under your arm.
If your cancer does not involve your skin and you would like to have immediate breast reconstruction, you may have a skin-sparing mastectomy.
- 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 all your breast tissue through this small opening.
- The rest of the skin over your breast tissue stays in place.
- To restore your breast, your reconstructive surgeon uses the same small opening to insert tissue taken from your abdomen (DIEP flap) or a temporary expander that is replaced later with an implant. Learn more about these breast reconstruction options.
A nipple-sparing mastectomy also uses a small incision, either under the fold of the breast or on the outer side of the breast, leaving the nipple and areola intact.
- This surgery 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 of the lymph nodes under your arm on the same side as your cancer to see if the cancer has spread there. Cancer in these lymph nodes increases the chance that cancer cells have spread to other parts of your body.
What Is Sentinel Node Biopsy?
Your surgeon locates and removes the first lymph nodes where your breast cancer might spread (the sentinel, or gatekeeper, nodes). Our experienced team of surgeons is led by David R. Byrd, MD, who pioneered sentinel node biopsy in the Pacific Northwest.
Then your sentinel nodes are checked for cancer.
- If the nodes are negative (cancer-free), you do not need any more lymph nodes removed.
- If the nodes contain cancer, your surgeon may need to remove some of your remaining lymph nodes (called axillary lymph node dissection).
What Is the Advantage of Sentinel Node Biopsy?
The fewer lymph nodes you have removed, the lower your risk of side effects, such as lymphedema (swelling) in your arm, nerve injury, and reduced range of motion. This is why we perform sentinel node biopsies whenever possible, rather than automatically removing more lymph nodes.
How Do You Treat 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.
- The Breast Cancer Surgery Patient Care Manual (PDF) is a general outline of what to expect from surgery.
- If you are considering breast reconstruction, read about reconstructive procedures performed for SCCA patients by plastic surgeons at UWMC.
- See resources from the American Cancer Society about breast prostheses, or breast forms, which some women use before or instead of breast reconstruction.