Surgery options for breast cancer

When you need surgery for early breast cancer, your team will discuss your treatment with you and options you may have. They will then ask you to make decisions about your treatment and care.

The aim of surgery is to remove the cancer from the breast, the lymph nodes in the armpit, or both.

It’s normal to feel overwhelmed by all the information. You usually have time to discuss the options and understand what is best for you.

You can ask your treating team how long you have to make your decision. They can answer any questions you have.

Lumpectomy (breast-conserving surgery)

Lumpectomy is also known as a partial mastectomy, breast-conserving surgery or wide local excision. Surgeons remove the breast cancer and a small amount of surrounding tissue. Radiotherapy after surgery is recommended for most people.

Mastectomy surgery

A mastectomy is surgery to remove the all of the breast tissue (single or 'unilateral' mastectomy) or both breasts (double or 'bilateral' mastectomy). 

Mastectomy may be recommended: 

• depending on the size of the tumour in relation to the breast size 
• if there is more than one tumour in the breast ('multifocal' breast cancer).

Types of mastectomy

Some people who need or choose a mastectomy also consider breast reconstruction. This may be:

• at the same time as their mastectomy surgery ('immediate reconstruction’)
• later ('delayed reconstruction') in a separate operation.

Others choose a mastectomy with no reconstruction (‘staying flat’). Either way, your surgeon will discuss these options with you before mastectomy surgery. Read When to decide about breast reconstruction.

If you are planning breast reconstruction, your surgeon may suggest a: 

Skin-sparing mastectomy: in this type of mastectomy, the breast tissue is removed but the skin is left.

Nipple-sparing mastectomy: the surgeon may be able to keep the nipple and the skin around the nipple (‘areola’).

These options may not always be possible, depending on where the tumour is.

Surgery to remove lymph nodes from the armpit

If you are having breast cancer surgery, your surgeon may remove some of your lymph nodes. Checking your lymph nodes for cancer cells helps your doctor decide the best treatment options for you.

There are 2 ways to remove lymph nodes:

• Sentinel lymph node biopsy
• Axillary dissection or axillary clearance.

Read about Lymph node and armpit ('axilla') surgery.

What affects the decision

You may have a choice between lumpectomy (breast conserving surgery) and mastectomy, if your surgeon thinks both would be appropriate. They will explain the options.

Some common factors affect your choice and your surgeon’s recommendation.

Your diagnosis

• the type and stage of your breast cancer (we explain these in Understand your pathology report)
• the size of your tumour (including its size compared to your breast size)
• whether there are multiple tumours in your breast or breasts
• whether all tumours are the same type of cancer
• how likely it is that breast cancer will come back ('recur') or progress.

Your history and health

• whether you carry a genetic fault (‘mutation’) that increases your risk of breast cancer
• whether you have had radiotherapy to the breast area before
• your age
• your general health and other medical conditions.

Your needs and expectations

• what your body will look and feel like after surgery
• your lifestyle - the activities and hobbies you want and need to do
• your personal needs, such as access to practical support and medical care 
• your financial situation and access to financial support.

Help to decide

• Read everything your surgeon gives you and use our resources to understand your options.
• Ask your surgeon and breast care nurse about anything you do not understand.
• Find tips and shared experiences in our Online Network from people who have been through surgery.
• Talk to your family and friends.
• Listen to our podcast about how to communicate with your health team. Breast cancer survivor Leslie Gilham and medical oncologist Professor Fran Boyle talk about communications and why there's no such thing as a silly question
• Read Cancer Australia’s ‘12 practices’ (videos and fact sheets) that explain what should and should not happen as part of your care.