Surgery for breast cancer

The aim of surgery is to remove the cancer and the area close to it. There are different ways of doing surgery for breast cancer. The best type for you will depend on the stage of your cancer. The main types are:

• Breast-conserving surgery (removing part of the breast)
• Mastectomy (removing the whole breast)

You may also have surgery to remove some or all of your lymph nodes. 

Breast-conserving surgery / wide local exision

Wide local exision removes only the breast lump and some normal tissue around it. If the lump is small, you may need to have a fine wire  / clip inserted into the breast before surgery. The wire marks the area to be removed. The wire is inserted under local anaesthetic by a radiologist during a mammogram or ultrasound. The wire is removed along with the cancerous area during surgery.

Treatment after surgery

You will need radiotherapy after surgery. This will help to reduce the risk of the cancer coming back in the breast. 

Scars

You will have a scar after wide-local exision. The position of the scar depends on where the tumour is and what type of surgery you have.

Checking the margins

After surgery, a pathologist examines the tissue removed to see if any cancer cells remain.

• Negative (clear) margins: No cancer cells are found at the edges of the tissue removed.
• Positive margins: There are cancer cells at the edges of the piece of tissue removed.

If you have a positive margin, it may mean that some cancer cells remain after surgery. Your surgeon may need to go back and remove more tissue. This operation is called a re-excision of margins. About 1 in 7 patients will need this operation. It may have to be done more than once.

If your surgeon cannot remove enough breast tissue to get clear margins, you may need to have a mastectomy.

Mastectomy 

In some cases, the best treatment is to remove the whole breast. This is called a mastectomy. 

After a mastectomy, you will be offered a breast prosthesis (breast form) and special bra to wear. Breast reconstruction is surgery that restores the appearance of your breast. It may be suitable for some women, either immediately at the time of mastectomy or later on. Read more about breast reconstruction.

Bilateral (double) mastectomy: This is when both breasts are removed. Reconstruction may be possible after having both breasts removed. Your surgeon will discuss this with you. 
 

If you feel you need support before or after surgery, you can talk to our cancer nurses. Visit a Daffodil Centre or call our Support Line on 1800 200 700.

After surgery

• After breast-conserving surgery, your hospital stay will probably be quite short. After a mastectomy or surgery to remove your lymph nodes, your stay could be several days or longer.
• You may have some pain or discomfort for several weeks after surgery. If your pain medication isn’t controlling your pain, tell your GP or hospital team so that they can change your medication. 
• A physiotherapist will advise you on the special arm exercises you need to do to prevent your arm and shoulder joint from getting stiff. If you have any difficulties with these exercises at home, you can usually contact the physiotherapist or breast care nurse. 
• You will probably be advised not to lift or carry anything heavy or drive for a few weeks.
• You may experience different sensations in your breast wound or scar. It may feel numb or be extra sensitive to touch.
• After the drains (tubes) have been removed, fluid may collect under the wound. This is called a seroma and can feel like a lump. Don’t worry if this happens. Tell your doctor or breast care nurse, who can drain the fluid with a needle, if necessary. 
• You will need to have radiotherapy after breast-conserving surgery. With mastectomy you may or may not need radiotherapy afterwards. 

Support after breast surgery

Whether you lose part of your breast or all of it, any change to your body image can be traumatic. Recovering emotionally from breast surgery can take some time. 

If you’re finding things difficult or feeling alone, remember that there are people who can help you. Tell your family and friends how you feel so they can support you. You can also talk to your breast care nurse. Counselling might help you too. 

It may help to talk to someone who has had similar surgery. Our cancer nurses can put you in touch with a trained volunteer who has been through a similar experience. Call our Support Line on 1800 200 700 or visit a Daffodil Centre and ask about Survivor Support or free counselling available at our affiliated cancer support centres.