Breast Cancer Surgery
ABOVE: Dr. Arpana Naik is a cancer surgeon, researcher and medical director of OHSU's breast cancer clinic. Her expertise includes advanced skills in oncoplastic lumpectomy for the best cosmetic result. BELOW: Dr. Rodney Pommier is also part of our surgical team.
The surgical oncologists (cancer surgeons) at the OHSU breast cancer clinic combine world-class skill with a deep understanding of breast cancer. They know that every patient is unique and that surgery is just one part of effective treatment.
Your surgical oncologist will:
- Make sure you understand all of your options.
- Tailor treatment recommendations to your wishes and long-term well-being.
- Offer the latest surgical techniques, including options (for eligible patients) such as nipple-sparing mastectomy.
- Work with the other doctors on your team to pair the best-possible cancer care with optimal cosmetic results.
Our surgical oncologists all completed their training with intensive fellowships at Memorial Sloan-Kettering Cancer Center, one of the world’s top cancer centers. They all have a particular focus on treating breast cancer patients.
As part of the Knight Cancer Institute, they are also researchers seeking to better understand breast cancer and how to treat it. This puts them on the leading edge of learning about new treatments and clinical trials.
Types of breast cancer surgeries
Your surgical oncologist will recommend options based on your cancer, your anatomy and other factors. It’s important to note that breast cancer surgery is usually combined with other treatments. You might have chemotherapy to shrink the tumor before surgery, for example, or you might be able to choose a smaller surgery if it’s paired with radiation therapy.
The surgeon removes the tumor and some surrounding tissue. Sometimes, lymph nodes are removed as well. (Read about lymph node surgery below.)
The amount of tissue removed can vary significantly, depending on the size and location of the tumor and other factors.
This surgery is also called breast-conserving surgery or breast-sparing surgery. It’s also a form of partial mastectomy because only part of the breast is removed, though partial mastectomy generally removes more tissue than a lumpectomy.Lumpectomy
The surgeon removes all the breast tissue. Most patients are eligible to have reconstruction as part of the same surgery, with the surgical oncologist and plastic surgeon planning procedures together.
- Simple or total mastectomy: The entire breast, including the nipple, areola and most of the skin, is removed.
- Modified radical mastectomy: Lymph nodes are removed along with the breast. (Read about lymph node surgery below.)
- Radical mastectomy: Lymph nodes and muscles under the breast are removed along with the breast. This surgery is done only if cancer has spread to the muscles.
- Prophylactic (preventive) mastectomy: One or both breasts are removed as a precaution for women at high risk of breast cancer.
Nipple- and skin-sparing mastectomy
Some patients who want a breast reconstruction may be candidates for nipple- and skin-sparing mastectomy. The surgeon can remove the breast tissue through an incision around the areola (the darker skin around the nipple), leaving an envelope for a particularly natural-looking reconstruction. Your surgical oncologist will make sure you are a good candidate to avoid increasing the risk of the cancer coming back.
This surgery combines cancer removal with reconstructive techniques. In oncoplastic lumpectomy, for example, your surgical oncologist removes the tumor, then the surgeon or a plastic surgeon sculpts the breast tissue to make sure no indentation is left behind.
In another common procedure, a lumpectomy on one breast is combined with a reduction on the other so the breasts stay the same size.
Lymph node surgery
If you have invasive breast cancer, your lymph nodes will be tested to see if the cancer has spread, and if so, how much. (Read more about the role of lymph nodes on our Understanding Breast Cancer page.)
- Sentinel lymph node biopsy: The surgeon uses a radioactive substance or dye to identify the first node filtering fluid from the breast tumor. The surgeon removes the node and often one or two nearby nodes. A pathologist checks the nodes for cancer cells, sometimes during cancer surgery. If no cancer is found, no other lymph nodes need to be removed. If cancer is found, the surgeon does an axillary lymph node dissection.
- Axillary lymph node dissection: Axillary lymph nodes (lymph nodes in the armpit), which filter lymphatic fluid from the breast, are removed to check for or remove cancer cells. The number of nodes taken out can vary, but it’s usually fewer than 20.