Surgery is often the first and most important step in treating breast cancer. The main goal is to remove the cancer completely with clear margins — meaning a rim of normal tissue around the tumour is also removed to reduce the risk of it coming back.
Types of Breast Cancer Surgery
There are several surgical options available. The best approach depends on your cancer type and size, breast shape and size, as well as your personal preferences and treatment goals.
1. Lumpectomy (Breast-Conserving Surgery)
Also known as wide local excision, this procedure removes the cancer along with a small margin of healthy breast tissue. It aims to preserve the appearance of the breast.
- Radiotherapy is typically recommended after surgery to reduce the risk of the cancer recurring in the same breast.
- Suitable for most early breast cancers.
2. Oncoplastic Surgery
This combines cancer removal with plastic surgery techniques to improve cosmetic outcomes — particularly useful when removing larger tumours or when there’s less breast tissue.
Techniques include:
- Tissue reshaping or rearrangement (e.g. round block or vertical mammoplasty)
- Local flap reconstruction using nearby tissue (e.g. LICAP or AICAP flaps)
- Therapeutic reduction mammoplasty, which may reshape both breasts for symmetry
The goal is to remove the tumour effectively while maintaining a natural-looking breast.
3. Mastectomy
This involves removing the entire breast. It may be recommended for:
- Larger cancers
- Multifocal cancers (more than one area)
- Certain genetic mutations (e.g. BRCA)
You may choose to:
- Go flat (no reconstruction)
- Have immediate or delayed reconstruction, depending on your cancer type and treatment plan.
4. Breast Reconstruction (click for more information)
Breast reconstruction restores the shape of the breast after a mastectomy and can be done using:
- Silicone implants
- Autologous tissue (your own tissue), such as:
- Latissimus dorsi (LD) flap
- TRAM flap (from abdominal muscle)
- DIEP flap (preserves muscle, uses abdominal skin/fat)
In many cases, nipple- and skin-sparing mastectomy is possible if reconstruction is done immediately.
💡 Choosing to have reconstruction is a personal decision. Some women feel more comfortable without it. Either way, you’ll be supported to make the decision that’s right for you.
Surgery to Assess the Lymph Nodes (Axillary Surgery)
The lymph nodes in the armpit (axilla) are assessed to determine if the cancer has spread beyond the breast. This helps guide your overall treatment plan.
1. Sentinel Lymph Node Biopsy
This is the standard method for axillary staging. On the day of surgery:
- A special dye and scan (lymphoscintigraphy) identify the first few lymph nodes — the sentinel nodes.
- These are removed and tested. If they are clear, no further lymph node surgery is usually needed.
The results help determine the stage of your cancer and whether additional treatment (like chemotherapy) is needed.
2. Axillary Lymph Node Clearance
If cancer is already known to have spread to the lymph nodes (e.g. proven on ultrasound and biopsy), a full removal of the lymph nodes may be needed.
🧠 Did you know?
For some patients with small, early cancers and no signs of spread, axillary surgery may not be necessary. Research is ongoing to identify when it can be safely avoided without affecting outcomes.
Risks of Breast Surgery
As with any surgery, there are general risks:
- Bleeding
- Infection
- Wound healing issues or need for additional surgery (e.g. to obtain clear margins)
- Changes in breast shape or asymmetry
Additional risks by surgery type:
- Oncoplastic/Reduction Mammoplasty
- May result in temporary or permanent asymmetry
- Follow-up surgery can adjust the opposite breast for improved symmetry
- Implant Reconstruction
- Risks include implant rupture, capsular contracture (hardening), rotation, asymmetry, or the need for revision surgery later
- Rarely, textured implants have been linked to BIA-ALCL, a rare lymphoma
- Autologous Reconstruction
- Risks at the donor site (abdomen or back) include bleeding, infection, fluid collection (seroma), or flap failure
🗨️ Talk to your surgeon about which option is safest and most appropriate for you. Every woman’s body, goals, and priorities are different.
What to Expect After Surgery
After Simple Surgery
(e.g. lumpectomy, simple mastectomy, or sentinel node biopsy):
- Usually an overnight stay in hospital
- If a drain is used (e.g. after mastectomy or axillary clearance), it’s usually removed after 4–5 days when output is low (<30ml/day)
- A nurse will assist you at home with drain care
- You can usually return to most daily activities within 2–4 weeks
After Complex Surgery
(e.g. oncoplastic surgery, reduction mammoplasty, or breast reconstruction):
- Hospital stay of 2–5 days
- Expect more tiredness and a longer healing process
- Take it easy for at least 3–4 weeks, and full recovery may take up to 2–3 months
- You may need physiotherapy or arm exercises, especially after axillary surgery
Final Thoughts
Being diagnosed with breast cancer is challenging, but understanding your surgical options can help you feel more in control. Whether you’re having a small lumpectomy or a more complex reconstruction, your surgical plan will be tailored to your body and your goals.
💗 You don’t have to make these decisions alone. Your care team will guide and support you every step of the way.