If you have been diagnosed with early or locally advanced breast cancer, you are likely to be offered surgery to remove the cancer. Some people may be offered chemotherapy before surgery to shrink the cancer and make it easier to remove (neo-adjuvant treatment).
You may be offered:
• breast-conserving surgery – where only part of the breast is removed
• mastectomy – where the whole breast is removed.
You will usually have one or more of the lymph nodes in your armpit removed at the time of your surgery. After your surgery you may be offered a breast prosthesis or breast reconstruction. You may also be offered additional treatments such as: radiation treatment, chemotherapy, hormonal therapy or targeted treatment.
If the cancer is in more than one part of your breast (multifocal) or is large compared to the size of your breast, you may be offered a mastectomy. It may also be needed if breast-conserving surgery is unlikely to be successful or the first surgery was unable to remove all of the cancer. Some people prefer to have a mastectomy if given the choice between this and breast-conserving surgery. Remember it is your body and your wishes are important.
A mastectomy is the removal of the whole breast including some of the skin and the nipple. In some cases, it may be possible to keep the nipple. The chest muscles are not removed. There will be scarring on your chest following your mastectomy. Breast reconstruction may be offered at the same time as your surgery or after any further treatment finishes.
After the surgery, you may be offered chemotherapy, hormone or targeted treatment.
Breast-conserving surgery is sometimes called a lumpectomy or a wide local excision. If your cancer is small compared to the size of your breast, you may be offered breast-conserving treatment. Breast-conserving surgery involves removing the breast cancer with some surrounding normal breast tissue. This surgery will leave a scar and may change the appearance of your breast.
After surgery you will most likely have radiation treatment to reduce the risk of the cancer coming back in the remaining part of your breast. If you need chemotherapy after your surgery (adjuvant treatment), any radiation treatment will be given after your chemotherapy is finished.
Checking the lymph nodes under the arm
Breast cancer cells can sometimes spread to the lymph nodes under your arm. You will have had an ultrasound of your armpit to check your lymph nodes. If the ultrasound is normal, then the sentinel lymph node(s) will be removed at the time of your breast surgery. This is to ensure there are no signs of cancer in the lymph nodes.
If the ultrasound shows abnormal lymph nodes, a biopsy will be done. If the biopsy shows cancer cells, then a lymph node dissection may be recommended. Or you may be referred for chemotherapy (neo-adjuvant chemotherapy) to treat the cancer before surgery. For some people radiation treatment to your armpit may be recommended instead of further surgery.
The first few lymph nodes that a breast cancer drains into are known as the sentinel nodes. There may be more than one of these nodes.
The sentinel lymph nodes are found by injecting a radioactive isotype and sometimes a blue dye around the nipple – this dye can remain noticeable for some time after. This makes the sentinel lymph nodes slightly radioactive, bright blue, and easier for your surgeon to find.
The sentinel nodes are removed so that they can be checked to see if they contain any cancer cells. If the sentinel nodes do not contain any cancer cells, it is unlikely that the cancer has spread.
Lymph node dissection
If any of the sentinel nodes do contain cancer cells, you will need to have more lymph nodes removed. You may hear this being called a lymph node dissection or axillary clearance. This operation may be done at the same time as your breast operation or later in a separate operation.
After the lymph nodes have been removed, you may experience shoulder stiffness, nerve pain or numbness in your upper arm, or long-term lymphoedema.
You may have a small drain in your wound site that drains extra fluid into a small container. If the fluid is not drained it can cause discomfort, delay wound healing and cause infection.
Many people go home with their drain still in place. If this happens, your treatment team will show you how to care for it and you may have a community health nurse visit you at home. The drain will be removed when the amount of fluid draining is small. Removing the drain is quick and can cause discomfort. Your treatment team will advise you about this. You will have a dressing over your wound. Follow any instructions given to you by your treatment team and ask them any questions you may have.
Side effects of surgery may include:
swelling caused by a build-up of fluid (seroma)
- wound infection pain in your arm due to changes in sensation or cording. Cording is
- often painful and looks like a tight cord running from your armpit,
- down your arm to the back of your hand
- reduced sensitivity of the inner side or down the back of your upper arm
- reduced range of movement in your shoulder
- risk of arm or chest wall swelling (lymphoedema).
Discuss possible side effects with your treatment team before your surgery. Any problems after surgery should be reported to them.
Go to this page for more information on managing side effects.
Check list of things to wear after surgery
• loose fitting nightwear that allows easy access to the breast, button-up shirts are helpful
• loose clothing to wear during the day
• a comfortable, soft bra – avoid wires and lace
• a singlet top, crop top or sports bras
• bra extenders – these can be helpful