Breast Cancer Surgery
Surgery is typically the first step in a treatment plan for breast cancer unless the cancer is very advanced.  Surgeons can remove the tumor using one two types of surgery.  Underarm lymph nodes are also removed and sampled at the time of surgery.

• Lumpectomy.  Also called breast conserving surgery or partial mastectomy, a lumpectomy involves surgically removing the tumor along with some surrounding tissue. As a result, a lumpectomy may allow a woman to preserve much of her breast and avoid the need for reconstructive surgery. The surgery is followed by radiation treatment.  Chemotherapy may be needed depending on the size of the tumor and lymph node involvement.
• Mastectomy.  Mastectomy involves the complete surgical removal of the breast.  A simple mastectomy removes all of the breast tissue, including the nipple.  A modified radical mastectomy includes removal of all of the breast tissue as well as removal of the axillary lymph nodes.  A radical mastectomy (during which surgeons also remove the chest wall muscles in addition to the breast and lymph nodes) is no longer performed. A skin-sparing mastectomy removes the breast tissue including the nipple while leaving much of the breast skin in place for reconstruction of the breast.  Breast reconstruction with mastectomy can be done at the same time as the mastectomy (immediate reconstruction) in coordination with a plastic surgeon, or may be done at a later time (delayed reconstruction). Chemotherapy may be needed depending on the size of the tumor and lymph node involvement.
• Sentinel Lymph Node Biopsy.  Sentinel lymph node biopsy is done at the same time as lumpectomy or mastectomy.  The main draining lymph node(s) from the breast are removed and sampled.  The lymph node is checked for breast cancer cells.  If no cancer is found, the chance of finding cancer in any of the remaining nodes is small and no other nodes need to be removed.
• Axillary Lymph Node Dissection.  This surgical removal of all of the lymph nodes under the arm is done if cancer is found in the sentinel lymph node or if needle biopsy shows that cancer has spread to the lymph nodes.  As with sentinel lymph node biopsy, this can take place with a mastectomy or lumpectomy. Cancer cells found in the lymph nodes increase the risk of the cancer spreading to other areas of the body.  This helps determine the best course of treatment, including whether chemotherapy or radiation therapy is needed.