Surgery

Surgery is usually the first stage of early breast cancer treatment. The aim of surgery is to remove the cancer cells from the breast. The cancer (tumour) is then sent to a pathologist who will develop a pathology report. This will help your medical team to decide the best treatment options for you. For more information about this, see breast cancer pathology. 

The two main types of breast cancer surgery are: 

• Breast-conserving surgery (also called lumpectomy, partial mastectomy or wide local excision). This involves the removal of the part of the breast affected by the cancer; and 
• Mastectomy. This involves the total removal of one or both breasts. 

In most cases, breast cancer surgery also involves the removal of one or more lymph nodes from the armpit (axilla). For more information on this, see types of surgery. 

In some instances, especially if you have a large tumour, chemotherapy or hormone-blocking therapy may be recommended before you have surgery. This will help to shrink the tumour before breast cancer surgery. This is called neoadjuvant therapy.

Making your decision

The type of surgery you have will depend on your particular breast cancer (the pathology) and your personal preference. It’s important to make sure you have all the information you need before you make a decision. Don’t be afraid to ask your surgeon questions, or to get a second opinion from another surgeon if you are unhappy with, or unsure about, the advice you receive.

If you are offered a choice between breast conserving surgery and mastectomy, ask your doctor if there is any reason she or he would recommend one over the other.

Breast-conserving surgery is often followed by a course of three to six weeks of radiotherapy. You may want to ask about radiotherapy before making your decision.

Before surgery, some women also ask for a referral to breast reconstructive surgeon or plastic surgeon if they think they may want to have a breast reconstruction. Some types of reconstruction are done at the same time as breast cancer surgery, so it is important to think about reconstruction before your breast cancer surgery.

See breast reconstruction for information about what’s involved.

Does your surgeon participate in the BreastSurgANZ Quality Audit?

If you are in the process of choosing a surgeon, you may wish to see if there is a surgeon in your area who participates in the BreastSurgANZ Quality Audit.

The Audit collects data and information from breast surgeons across Australia and New Zealand about the treatment and care of women with breast cancer. The Audit was established in 1998 with the purpose of improving the quality of care for women with breast cancer. It now has more than 300 surgeons from Australia and New Zealand participating in the reporting process.

Information about some of the research that has resulted from the data collected through the Audit can be found on the BreastSurgANZ Quality Audit page.

Your stay in hospital

The amount of time you spend in hospital will depend on the type of surgery you have and how you respond to it. Your surgeon can give you an idea of what to expect.

Here are some tips from other women to help make your hospital stay more comfortable:

• Buy some pyjamas that button at the front. They are easier for you to manage, and make it easier for your medical team to check your dressings.
• If you are sharing a room or are easily disturbed, pack earplugs and/or a music player.
• If you have a breast care nurse, ask them to order you a free My Care Kit. The kit contains a Berlei bra which has been specially designed for women to wear after breast cancer surgery.

Side effects of surgery

The side effects you experience will depend on the type of surgery you receive. Other factors such as your general health and wellbeing can also play a part in how side effects may affect you. 

It is important to remember that some people have very few side effects. 

Side effects may include: 

Pain

Pain and discomfort are common while wounds are healing after breast surgery (lumpectomy, mastectomy, breast reconstruction), but everyone's experience is different. Pain is usually temporary and becomes less severe over time. It might take several weeks before you have healed from surgery.

Your shoulder may become stiff and sore after surgery. Your nurse or physiotherapist will provide you with information about exercises after surgery to help your shoulder mobility.

Some people may experience numbness and nerve-pain (shooting or burning pain) in the area affected. This is due to damage to the nerves during surgery. The nerves usually repair themselves but it can take a number of weeks or months. Talk to your doctor or nurse about medications that help with nerve pain. Read more about managing pain related to breast cancer treatment.

Seromas

Seromas are collections of fluid which occur in the area where the surgery took place. They are quite common following surgery. In most cases the fluid will be absorbed by your body over time. If it is uncomfortable, it can be drained by a member of your medical team.

Cording

Cording is a common side effect of breast cancer surgery. Cording refers to the development of tender vertical ‘cords’ in the armpit after the lymph nodes have been removed. Cording creates a pulling sensation down to the elbow or wrist. It is not harmful, but if tender, a warm pack on the area may help to reduce discomfort. Cording usually disappears by itself within a few months. If you are having trouble with cording, a physiotherapist can help you with gentle massage and exercises.

Lymphoedema

Lymphoedema is swelling in the arm or the breast following the removal of lymph nodes in the armpit. You can find more information at lymphoedema.