Breast Cancer Surgery
Surgical treatment of breast cancer, selected according to tumour characteristics, stage and individual needs
What is breast cancer surgery?
Breast cancer surgery settles two questions in the same operation: what is removed from the breast, and what is checked in the armpit.
In the breast, your surgeon either removes the lump with a rim of healthy tissue around it and keeps the rest of the breast, or removes the whole breast. Both are standard operations and the choice turns on the size and position of what is being removed, how many areas of the breast are involved, the size of your breast, and your own preference. Where the ratio is unfavourable, treatment given before surgery can shrink what has to be taken and change which operation is possible.
The armpit is assessed at the same sitting. Where the lymph nodes appear normal on scans and on examination, a dye or a radioactive tracer is used to identify the first few nodes the breast drains into, and only those are removed for the laboratory to examine. Where the nodes are already known to be involved, a fuller clearance of the armpit is done, which is a bigger operation with more consequences for the arm. Reconstruction, immediate or delayed, is planned with you beforehand.
What it involves
You are admitted the day before or on the morning of surgery. If a tracer is being used for the armpit, it is injected a few hours earlier in the nuclear medicine or radiology department, and if the area is not easily felt, a radiologist may place a fine wire or a marker to guide the surgeon to it.
The operation is done under a general anaesthetic, so you are fully asleep and aware of nothing. Removing the lump with an armpit sampling takes about an hour and a half; removing the whole breast, or clearing the armpit, takes two to three hours; adding reconstruction can take considerably longer.
You wake in the recovery area with a dressing and usually one or two soft drains, which are thin tubes carrying fluid away from the wound into a bottle you carry. You will be encouraged out of bed the same evening and started on gentle shoulder movements the following morning. Most people stay one to three nights, longer where the whole breast has been removed or reconstruction has been done, and drains sometimes go home with you and are removed in clinic.
Recovery
The wound is sore for about a week and manageable with tablets. Numbness in the skin over the operated area and on the inner side of the upper arm is expected after armpit surgery, and it can be permanent.
The physiotherapy exercises matter more than they look. Start them on the schedule you are given and keep going, because a shoulder that is protected out of caution stiffens and takes months to free again. Avoid heavy lifting and pushing for four weeks. Most people drive again at two to three weeks, once they can turn the wheel fully and make an emergency stop without hesitating. Desk work is usually possible at three to four weeks, physical work at six to eight.
Wear the soft support bra you are given, day and night at first. The laboratory report on what was removed comes back in about a week to ten days, and it is what decides whether further treatment is needed and when it starts. Any further treatment usually begins around four to six weeks after surgery, once the wound has healed.
Questions about breast cancer surgery
Will my whole breast have to be removed?
Often it does not. Where the area can be removed with a clear rim of healthy tissue and leave an acceptable shape, keeping the breast and following with radiotherapy gives results equivalent to removing it. The factors that push towards removing the whole breast are a large area relative to breast size, more than one separate area, disease spread widely through the ducts, an inability to have radiotherapy, or your own preference. Treatment given before surgery can shrink the area and change the answer. Ask your surgeon to describe both options for your particular situation, including what the breast is likely to look like, before you decide.
When can I use my arm normally and go back to work?
Start the shoulder exercises you are given the morning after surgery and keep doing them, because a shoulder rested out of caution stiffens and takes months to free again. Expect the wound to be sore for about a week. Avoid heavy lifting and pushing for four weeks. Most people drive at two to three weeks, once they can turn the wheel fully and stop suddenly without hesitating. Desk work is usually possible at three to four weeks and physical work at six to eight. Numbness over the outer breast and the inner upper arm is expected after armpit surgery and can be permanent, though it does not limit what the arm can do.
What is lymphoedema and how likely am I to get it?
Lymphoedema is persistent swelling of the arm caused by disrupted lymph drainage after nodes are removed from the armpit. It is uncommon when only the first few draining nodes are sampled and considerably more likely after the armpit is fully cleared, more so again if radiotherapy follows. It can appear months or years afterwards, so it is worth knowing the early signs: a ring or sleeve that starts to feel tight, or a new heaviness in the arm. It is managed with compression, exercise and specialist therapy and responds much better when treated early, so report any new swelling promptly instead of waiting for the next review.
Other surgical oncology treatments
Surgical treatment of cancers affecting the colon or rectum
InpatientSurgical management of selected stomach cancers as part of a multidisciplinary treatment plan
InpatientTalk to a care coordinator about breast cancer surgery
Leave a number and a care coordinator calls you back with what the treatment involves and which hospital it would be at. They book a consult only if you want one