Breast Surgery

Breast cancer surgery may include surgery to remove cancer from the breast and lymph nodes from under the arm.

Breast conserving surgery involves removing the primary cancer from the breast (also called a "lumpectomy," "partial mastectomy," or "quadrantectomy") with a margin of normal tissue while leaving the rest of the breast intact. Breast conserving therapy is usually a combination of surgery to remove the cancer followed by radiation to the breast.

Mastectomy - removal of the entire breast - may be a better treatment option for some patients.

Doctors have found that if the primary tumor cannot be completely removed with negative margins, the risk of having the cancer come back in the breast is unacceptably high, even with radiation after the surgery. Thus, individuals with large tumors or those with multiple sites of cancer in the same breast may be recommended to undergo a mastectomy.

This is surgery to rebuild the breast shape - may be considered at the time a mastectomy is done (immediate reconstruction) or after finishing treatments in the future (delayed reconstruction). The reconstructed breast may be made with the patient's own (non-breast) tissue or by using implants filled with saline or silicone gel.

In addition, some patients undergoing lumpectomy for a large tumor or those with large breast size, may be candidates for a different type of breast reconstruction to minimize a defect from the surgery, called oncoplastic surgery. 

Learn more about the extensive services available to you by visiting the Breast Reconstruction Surgery website.

At the time of primary breast cancer surgery, most patients have evaluation of their axillary nodes, to determine whether the cancer has spread there. This evaluation helps to determine the stage and treatment plan.

When the lymph nodes feel normal by physical exam, a procedure called a sentinel lymph node biopsy (SLNB) is typically performed to evaluate whether microscopic breast cancer cells have spread to the lymph nodes. A SLNB involves removing the first lymph nodes that drain the breast, called the sentinel nodes, and evaluating those for cancer.

In some situations when breast cancer cells have travelled to the lymph nodes, it is necessary to remove the surrounding axillary lymph nodes in a procedure called an axillary lymph node dissection (ALND). This allows doctors to determine how many lymph nodes are affected.

The lymph node details often help determine treatment recommendations, such as whether chemotherapy is necessary and whether radiation to the surrounding tissue is appropriate. The number of lymph nodes involved will help determine whether chemotherapy is recommended.

Removing axillary lymph nodes can lead to swelling in the arm, a condition called lymphedema.

The Weiser Family Center for Breast Cancer has an integrated lymphedema screening program which aims to identify and treat early signs of arm swelling to decrease the risk of long-term lymphedema. In addition, some patients may be appropriate for a surgical procedure, called a lymphovenous anastomosis (LVA) to reduce risk of arm swelling as well.

Breast surgery is performed at the main University of Michigan hospital, East Ann Arbor Ambulatory Surgery Center, the Brighton Center for Specialty Care, and Chelsea. When indicated, tissue samples may be examined microscopically while the patient is still under anesthesia. Based on the lab's findings, surgeons can decide to remove additional tissue during the same surgery.