Breast Cancer Surgery

April 10, 2025

This page was reviewed under our medical and editorial policy by Susan Yost, Ph.D., staff scientist, Department of Medical Oncology & Therapeutics Research, City of Hope^® Cancer Center Duarte

Breast surgery is the most common treatment for breast cancer. The primary goals are eliminating cancerous tissue and maintaining as much healthy tissue as possible.

Surgery may be combined with other treatments like chemotherapy or radiation therapy, either before or after the procedure. Most patients with breast cancer will undergo some form of surgery as part of their comprehensive treatment plan.

Breast Cancer Surgery Types

There are several types of breast cancer surgeries, including lumpectomy, mastectomy and lymph node removal.

The choice of surgery depends on various factors, including the stage and type of breast cancer, the size of the tumor and patient preferences. Some patients may need radiation therapy or chemotherapy for breast cancer before surgery to shrink the tumor, while others may proceed directly to surgery.

Lumpectomy or Breast-Conserving Surgery

A lumpectomy, also known as breast-conserving surgery or partial mastectomy, involves removing the cancerous tumor while retaining as much normal breast tissue as possible. This procedure typically includes removal of some nearby healthy tissue and possibly nearby lymph nodes.

Lumpectomy is often recommended for early-stage breast cancers or when the tumor is small relative to the breast size. It is an option for patients who are willing to undergo radiation therapy for breast cancer afterward, as this therapy is usually needed to target any remaining cancer cells.

Lumpectomy may not be suitable for everyone. It is generally not recommended for patients who have had previous radiation to the breast. It is also generally not recommended for those who have multiple tumors in different quadrants of the breast or who have a genetic mutation like BRCA that increases the risk of a second breast cancer.

Despite these considerations, choosing lumpectomy plus radiation therapy over mastectomy does not affect long-term survival rates, making it a viable option for many patients.

Mastectomy

A mastectomy involves removing the entire breast, and it is recommended for various stages and types of breast cancer. This surgery may be necessary when breast-conserving surgery (lumpectomy) is not an option, as in cases with larger tumors, multiple cancer sites in different breast quadrants or previous radiation treatment. Some women may choose mastectomy for personal reasons or if they prefer to avoid radiation therapy.

Mastectomy is also a consideration for women at high risk of developing a second breast cancer, such as those with a BRCA gene mutation, who may opt for a double mastectomy (removal of both breasts) as a preventive measure. Additionally, it is suitable for patients with conditions like inflammatory breast cancer or those who are unable to undergo radiation therapy due to pregnancy or other health conditions.

The choice between mastectomy and breast-conserving surgery often involves a thorough discussion with the care team to tailor the approach for each patient’s unique situation.

Surgery to Remove Lymph Nodes

Lymph node removal is a procedure used to determine whether cancer has spread to the axillary (underarm) lymph nodes. It plays an important role in staging the cancer. This surgery may be performed either during the main breast cancer operation or as a separate procedure.

There are two main types of lymph node removal surgeries, as detailed below.

Sentinel lymph node biopsy (SLNB): In this procedure, a dye is injected to identify which lymph nodes are most likely to be affected by the cancer. The surgeon then removes these specific nodes, which reduces the risk of side effects like lymphedema, or arm swelling.

Axillary lymph node dissection (ALND): This procedure involves removing multiple lymph nodes, usually fewer than 20, without using dye. Although this method is less common today, it may be necessary when a thorough examination of the lymph nodes is needed.

Breast Reconstruction After Surgery

Breast reconstruction is an option for many patients undergoing surgery for breast cancer. Depending on individual factors and personal preferences, reconstruction may be performed either immediately after a mastectomy or lumpectomy, or at a later time.

Several types of reconstructive surgeries are available for those who choose it, ranging from implant-based reconstruction to using tissue from other parts of the body to rebuild the breast. For those undergoing breast-conserving surgery, fat grafting might be an option to fill in any dimples or irregularities left by the procedure.

It is important to discuss reconstructive options with both the breast surgeon and a plastic surgeon before the mastectomy or lumpectomy. This allows for a coordinated approach tailored to the patient’s medical needs and personal wishes.

Oncoplastic Surgery

Oncoplastic surgery combines cancer surgery with plastic surgery techniques to reshape the breast during a lumpectomy or partial mastectomy. This approach is often used for women with early-stage breast cancer to maintain the breast’s appearance after removing the tumor. Techniques may include moving nearby tissues, breast reduction or transferring tissue flaps.

Oncoplastic surgery aims to achieve a balance between appropriate cancer treatment and aesthetic outcomes, with long-term results comparable to standard breast-conserving surgeries. This option allows patients to address both medical and cosmetic concerns in a single procedure.

How Long From Breast Cancer Diagnosis to Surgery?

The time between a breast cancer diagnosis and surgery may vary, but surgery is typically performed within a few weeks to a month.

The period between diagnosis and surgery allows for necessary steps, such as additional imaging, genetic testing and consultations with specialists like plastic surgeons and radiation oncologists. These steps are necessary to gather additional information that lets the patient make informed decisions about the type of surgery and overall treatment plan.

In a 2023 study of more than 350,000 U.S. patients with Stage 1 to 3 breast cancer published in JAMA Surgery, half of the patients had surgery within 30 days, and 88% of patients had surgery within 57 days, which was tied to improved survival than waiting beyond eight weeks for surgery. The study suggested that having surgery within a span of eight weeks may give patients the time they need to make decisions without affecting overall outcomes.

It is important to balance adequate time for decision-making with the need to avoid prolonged delays so that patients are well-informed and comfortable with their treatment decisions.

Breast Cancer Surgery at City of Hope^®

World-Class Breast Cancer Care

City of Hope offers breast cancer patients state-of-the-art diagnosis and treatment options, including a wide range of innovative, minimally invasive procedures performed by internationally recognized breast cancer surgeons. We are also home to leading-edge clinical trials, which bring new treatments to patients with life-saving speed, and to our comprehensive supportive care program, designed to help women manage both the physical and emotional side effects of breast cancer.

As part of our goal to offer individualized, compassionate care, our surgical team has pioneered new microsurgical procedures that help maintain both the look and feel of the breast after reconstruction — all while protecting against the most common side effects of breast surgery, such as lymphedema.