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Breast Cancer Surgery Options

Knowing your options can help you face cancer head on

Woman after undergoing chemotherapy

From the awkward excitement of putting on your first training bra to the profound tenderness of nursing your first baby, you have a deeply personal relationship with your breasts. But when women are diagnosed with breast cancer, that relationship is forever changed.

"It's not just a cosmetic thing; it’s a whole body issue, it's your sense of self," says Katherine Kopkash, MD, a breast surgeon at Rush.

Surgery is considered the primary treatment for breast cancer; the only women who do not typically have surgery are those who have metastatic breast cancer that has spread to places like the liver or bones.

However, breast cancer is unique compared to other cancers that are treated surgically because there are more surgical options for breast cancer. While doctors will certainly educate you about your options, the decision about which surgery to have is ultimately yours.

Making that decision with confidence starts with knowing what you're up against and using that knowledge to make the best choice for yourself. These six steps can help you get started.

1. Choose your own path. Forty years ago, the only surgical option for treating breast cancer was a mastectomy (removal of the breast).

Today, mastectomy is typically done if you have more advanced breast cancer, if you are a smaller-breasted woman with a large breast tumor, or if you have a genetic mutation that increases your risk for cancer. And unlike several decades ago, you can choose to have breast reconstruction surgery, often at the time of your mastectomy, to rebuild the shape of your breast.

But some women with breast cancer can also choose a less invasive surgical option. Breast conservation (also known as lumpectomy) involves removal of the tumor and some breast tissue, while saving the rest of the breast and then treating the breast with radiation therapy. This may be a good choice if you have a less advanced stage of cancer.

2. Learn your chances of survival. Your top concern after being diagnosed with breast cancer is curing the cancer. The good news is that your chances of survival are the same whether you opt for breast conservation or a mastectomy. "That’s why so many women have both surgical options open to them," says Kopkash.

Also, whether or not you'll need additional treatments, such as chemotherapy and hormone therapy, are typically the same regardless of which surgery you choose.

There is, however, a slightly higher risk that the breast cancer will return (also known as breast cancer recurrence) if you've had breast conservation because the remaining breast tissue can still be at risk.

3. Get the facts. Having a mastectomy does not always mean removing both breasts. Yet more women today are choosing to have a double mastectomy, even if the cancer is just in one breast. While this may provide peace of mind, studies have found that a double mastectomy may lower your chance of recurrence, but it does not improve survival.

In fact, doctors typically only recommend having both breasts removed (also known as bilateral mastectomy) if you have breast cancer in both breasts or if you carry the BRCA1 or BRCA2 gene, which increases your risk of developing breast cancer.

4. Take your time. Most breast cancers are relatively slow growing compared to many other types of cancer.

"If you need to think about it for a week or two or three, you can," says Kopkash. "We don't need to rush you to surgery the day you are diagnosed. It's so important to make the right decision, because once it's done, it's done; it's not something you can take back."

Do your research, talk to women who have been through it — both mastectomy and breast conservation — and ask your doctor plenty of questions.

5. Know that you can still have beautiful breasts. "There are so many times when women come into my office and they’re just devastated," says Kopkash. "But then they realize their options. They learn that we can take out the cancer and they still have the breasts they want. It offers a positive outlook on such an awful thing."

6. Explore your options for breast reconstruction. You may choose to have breast reconstruction at the same time as your mastectomy.

Or, you can have staged breast reconstruction, a procedure in which your surgeon inserts a tissue expander that helps your skin grow and stretch to prepare the area for reconstruction. Although this process takes a few months, there are fewer operative risks, and you still get a very natural look.

Depending on your breast size and your cosmetic goals, there are some options for breast reconstruction:

  • Implant procedures use saline or silicone gel-filled implants to reconstruct the shape and look of your breast. After the breast cancer surgeon removes the tumor and breast tissue, a plastic surgeon will place the implant under your chest muscles. You can have this procedure at the same time as your mastectomy, or after your mastectomy if you need radiation or other treatments.
  • Tissue flap procedures use tissue from your stomach, back, thighs or buttocks to rebuild the breast. These very complex procedures are done by skilled plastic surgeons who specialize in microvascular breast reconstruction. Flap procedures have evolved in recent years, giving women more options and safer options than they had 10 years ago.
  • Reduction lumpectomy is a relatively new option for women having breast conservation surgery. In this procedure, a breast cancer surgeon can remove the tumor and then often works as a team with a plastic surgeon to perform a breast reduction or lift for women who have large or sagging breasts.

While inherited cancers are somewhat rare, approximately 5 to 10 percent of breast, ovarian and colon cancers are caused by hereditary factors. Fortunately, recent medical advances make it possible to turn this knowledge of family history into preventive measures.

A breast cancer patient at Rush gives her personal story of her experience of the disease and living a full life in spite of it.

A Rush oncologist provides background on breast cancer, including who gets it, how it is treated, and how it can be prevented.