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Breast Cancer Surgery

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Just about every breast cancer patient will need to have surgery at some point during their treatment process. The right type of surgery for you depends on several factors including the size of the tumor, location in the breast, and your overall health status. As part of a multidisciplinary cancer care team the surgeons at Rocky Mountain Breast Specialists (RMBS) work with each patient to identify the best type of breast cancer surgery and the right timing. They’ll also work closely with your medical oncologist. If you don’t have one yet, they can help you find a breast cancer specialist near you. During your consultation, the surgeon will discuss a recommended procedure. Meet our breast cancer surgeons and learn more about the most common breast cancer surgeries.

Meet Our Breast Cancer Surgeons

Get to know our breast cancer surgeons who have dedicated their careers to the treatment of breast cancer and perform hundreds of breast cancer surgeries every year. 

 

Oyague_Katrina

Katrina Oyague, MD, FACS

Breast Surgeon
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Tynan-Gerlinde

Gerlinde Tynan, MD, FACS

Breast Surgeon
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There are many doctors who perform breast cancer surgery, most of them do not specialize in breast cancer quite like a breast surgical specialist does. Learn more about how to choose the right breast surgeon. 

What is the Difference between a Lumpectomy and a Mastectomy?

Dr. Tynan explains the differences between lumpectomy and mastectomy, covering what each surgery involves, benefits, and key considerations to help patients understand their options.

 

 
 

Lumpectomy

Breast-conserving surgery, also called lumpectomy, involves removing the cancer and some surrounding healthy tissue but not the entire breast. Your breast surgeon may also remove lymph nodes under the arm to check them for any cancerous cells. Learn about the types of lymph node biopsies and how they are performed.

There are a few different types of lumpectomies including oncoplastic lumpectomy and localized lumpectomy.

Oncoplastic Lumpectomy

Oncoplastic lumpectomy is the combination of lumpectomy surgery with plastic surgery techniques to give you a better cosmetic outcome after the cancer is removed. In simple terms, it is a reconstructive surgery that can improve the appearance of the breast if it was altered because of the lumpectomy. In many cases, the nipple can stay intact. 

There are several different oncoplastic approaches that your surgeon can use to reshape the breast after removing the cancer. The size and location of the cancer, as well as the woman’s breasts, body, and preferences, will determine which approach would be best.  

Oncoplastic surgery techniques are generally used to: 

  • Prevent “dents” in the breast.
  • Place the scar where it’s less visible. This is sometimes referred to as Hidden Scar.
  • Combine the removal of cancerous breast tissue with a breast reduction, breast lift, or both. 

If necessary, your RMBS breast cancer surgeon can make adjustments to the other breast to create a balanced appearance. Keep in mind that oncoplastic lumpectomy is not ideal if you have inflammatory breast cancer because it’s so widespread throughout the breast. If you have multiple tumors found throughout the breast, a mastectomy may be recommended.

Localized Lumpectomy

Localized lumpectomy, sometimes called an excisional biopsy, refers to a procedure that is used when an abnormality is found on a mammogram or ultrasound, but cannot be felt by your surgeon (palpated). There are a couple of different ways a localized lumpectomy can be performed: 

  • Wire-guided localization. This procedure involves using a needle to place a wire into the breast before your surgery, on the same day. Your surgeon follows this wire as a guide to the precise location of the abnormal breast tissue or cancer. The wire will be removed with the area of abnormal breast tissue.
  • Wire-free localization. Newer technology is making it possible for surgeons to more accurately pinpoint lesions prior to surgery. One technology is called the SAVI SCOUT system. The surgeon places a small, 1 cm device called a reflector in the breast tissue rather than a wire. This is done up to seven days prior to surgery. On the day of surgery, your surgeon will use a hand-held device that emits a tiny radar signal to find the reflector inside your breast to identify where the breast tissue needs to be removed.

Mastectomy

Surgery to remove the entire breast is called a mastectomy. Oftentimes lymph nodes are also removed at the same time. These lymph nodes will be evaluated to see if there are cancer cells present in them. The presence or absence of cancer cells in the lymph nodes will direct the future treatments needed. There are a few different types of mastectomy. The right one for each patient will be discussed with the breast surgeon.

In addition to removing the breast tissue, the surgeon also removes the nipple, areola, fascia (covering) of the pectoralis major muscle (main chest muscle), and skin. A sentinel lymph node biopsy may also be performed at the same time.

breast-total-simple-mastectomy

 

This is a total mastectomy combined with an axillary lymph node dissection rather than a sentinel lymph node biopsy.

Whenever possible, a nipple-sparing and skin-sparing approach is used, allowing women to keep more of their own breast tissue. This is both a cosmetic and emotional benefit to many women.

During a skin-sparing mastectomy, the nipple and areola are removed along with the breast, but only a small amount of skin is removed. Nipple-sparing mastectomy keeps the nipple and areola intact along with the breast skin. 

When possible, your RMBS breast surgeon will place the incision in a strategic area that can result in less obvious scar tissue after healing. This can help maintain much of the female form and sensation, which we know is important to many patients.

Risk-reducing mastectomy (RRM), also known as prophylactic mastectomy (PM), is performed to reduce the risk of developing breast cancer or breast cancer recurrence. High-risk women, including women with a strong family history of breast cancer and the BRCA 1 or 2 gene mutation, might be a candidate for this type of breast cancer surgery.

 

What You Need to Know About Lumpectomies and Mastectomies

Breast Cancer Surgery Frequently Asked Questions

When receiving a breast cancer diagnosis, many women are ready to have the tumor removed as soon as possible. This is an understandable reaction. It may, however, be best to start with a medical oncologist who specializes in breast cancer, like those at Rocky Mountain Breast Specialists (RMBS). They will review your images and biopsy report to determine if additional tests are needed so they can create a comprehensive breast cancer treatment plan that includes surgery. 

You may choose to have an RMBS breast surgeon perform your surgery or another breast cancer surgeon in the Denver or Colorado Springs area. In either case, the RMBS medical oncologist will discuss your test results and recommended treatment plan with the surgeon to ensure they’re aligned on the right timing for surgery. 

You’ll also consult directly with your breast cancer surgeon to discuss the right procedure for you.

Chemotherapy before breast cancer surgery is not recommended for everyone. However, if the tumor is large, the cancer is growing quickly, or it has spread to nearby lymph nodes, it may be recommended. HER2-positive, triple-negative, high-grade breast cancers, and inflammatory breast cancer are the most common types that require treatment before surgery. 

By treating the tumor before surgery, it can shrink to allow for less invasive surgery, such as a lumpectomy instead of a mastectomy. It also helps doctors see how well the cancer responds to treatment, which can guide future care. In some cases, it may reduce the need for extensive lymph node surgery. Overall, neoadjuvant chemo is used to make surgery safer and more effective while giving patients more options for breast preservation.

Whether a lumpectomy or a mastectomy, you can expect some scarring. Our breast cancer surgeons use techniques to place cuts in ways that help reduce how noticeable the scar is once healed. If you plan to have breast reconstruction or choose to go flat (no reconstruction), talk with your surgeon ahead of time. Your surgeon needs to know your goals because that changes where and how they close the incision.

Radiation therapy is usually recommended after a lumpectomy because it lowers the chance that the cancer will come back in the breast. Studies show that lumpectomy followed by radiation works about as well as removing the whole breast in preventing cancer from returning. If radiation after a lumpectomy is part of your recommended breast cancer treatment plan, you will meet with one of our radiation oncologists at a location that’s convenient for you through the greater Denver, Boulder, or Colorado Springs areas. 

They will discuss how external beam radiation therapy works and the number of treatments you will receive. Many of the Rocky Mountain Breast Specialists benefit from hypofractionated radiation therapy. This process delivers the total radiation dose in fewer sessions, with no additional side effects for most patients. Sessions can be completed in 3-5 weeks, down from 6-8 weeks previously.

Radiation is not usually given after every mastectomy. Your oncologist may recommend it if the cancer was large, had spread to lymph nodes or the chest wall, or was found very close to the edges of the removed tissue. In those cases, radiation can help lower the risk that cancer cells left behind will grow back in the chest wall or nearby lymph nodes.

Even if you have a lumpectomy, there may be some surgical reshaping of the breast or resizing of the other breast to match the one that had the tumor removed. This is common and can often be done at the same time as the surgery to remove the cancer. 

Women who have a mastectomy can decide if they would like to go flat, meaning no breast reconstruction, or if they would prefer to have the breast reconstructed. There are several options for the way breast reconstruction can be performed. Talk to your surgeon or a plastic surgeon about what you’d like to do and which options are available to you. 

Breast Cancer Education Center

Want to learn more about breast cancer? Our breast cancer education center includes articles, videos, and patient stories. 
 
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Consider Your Future Reconstruction Options Before Cancer Removal Surgery

While the breast cancer surgeon doesn’t typically place implants at the time of the breast cancer removal surgery, they can help prepare your body for future reconstruction. Advanced oncoplastic techniques can be incorporated at the time the cancer is removed. Talk to your surgeon about what you think you’d like to do regarding reconstruction so you can develop a plan before cancer removal surgery.

Breast Reconstruction Options