Key Facts to Know about Breast Cancer Surgery

Maria Nelson, MD, a breast surgical oncologist with the USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC, shares important facts about surgical treatment for breast cancer. 

If you’ve been diagnosed with breast cancer and your treatment plan includes surgery, your first thoughts may understandably center around fear and uncertainty. Surgery for breast cancer can feel overwhelming, but understanding the different surgical options — including the difference between a lumpectomy and mastectomy — can help patients feel more informed and prepared as they move through treatment. 

Breast cancer care is not one-size-fits-all 

Not all breast cancers are treated the same way. Treatment recommendations depend on many factors, including the biology of the cancer, tumor size, stage, genetics and a patient’s personal goals and preferences. 

“Breast cancer is a very individualized disease, and treatment should reflect that,” says Maria Nelson, MD, a breast surgical oncologist with the USC Norris Comprehensive Cancer Center, part of Keck Medicine of USC. “Two patients can have breast cancer and still require very different treatment approaches based on the specifics of their disease and what matters most to them as individuals.” 

Because of this, patients should not compare their treatment plans too closely to what friends, family members or online resources describe. 

Lumpectomy vs. mastectomy: What is the difference? 

The primary goals of breast cancer surgery are to remove the cancer and determine whether it has spread beyond the breast. 

“In breast cancer surgery, we are typically thinking about two separate areas — treatment of the breast itself and evaluation of the lymph nodes,” Dr. Nelson explains. 

From the breast standpoint, there are generally two surgical approaches: 

• Lumpectomy — removal of the cancer along with a margin of surrounding tissue while preserving the remainder of the breast 
• Mastectomy — removal of the entire breast 

“The decision between lumpectomy and mastectomy is often more nuanced than patients initially expect,” Dr. Nelson says. “Factors such as tumor size relative to breast size, extent of disease, the need for radiation, genetic risk and patient preference all play an important role.” 

Importantly, for many patients, lumpectomy followed by radiation can offer outcomes comparable to mastectomy. 

What should you know about a lumpectomy? 

Most lumpectomies are outpatient procedures, meaning patients typically go home the same day. 

“Recovery after a lumpectomy is usually relatively quick,” Dr. Nelson says. “Most patients experience some soreness and fatigue, but pain is often manageable and many patients return to normal activities within two weeks.” 

Patients will still have a scar and may notice temporary swelling or changes in breast shape depending on the amount of tissue removed. 

What should you know about a mastectomy? 

A mastectomy involves removal of the entire breast and may be performed on one side or both sides. 

“The recovery process after mastectomy depends significantly on whether reconstruction is being performed,” Dr. Nelson explains. “When reconstruction is part of the plan, surgery and recovery can become more complex and involve close coordination with a plastic surgeon.” 

The decision about reconstruction is highly personal and should involve detailed discussions about expectations, recovery, timing and surgical options. 

“If reconstruction is not performed, many patients stay overnight in the hospital and go home the following day,” Dr. Nelson says. 

What is lymph node surgery for breast cancer? 

Lymph node surgery helps determine whether breast cancer has spread outside the breast. 

“The first lymph node that drains the breast is called the sentinel lymph node,” Dr. Nelson explains. “If cancer were to spread through the lymphatic system, this would typically be the first node involved.” 

To identify the sentinel lymph node, surgeons inject substances — often a blue dye and/or radioactive tracer — into the breast. These substances travel through the lymphatic channels and help guide the surgeon to the appropriate lymph node for removal and testing. 

“We remove the sentinel node and have it analyzed to determine whether cancer cells are present,” Dr. Nelson says. “Whether additional lymph nodes need to be removed depends on several factors and requires careful discussion between the patient and the surgical team.” 

The importance of multidisciplinary breast cancer care 

Breast cancer treatment continues to evolve, and treatment recommendations are increasingly personalized. 

“One of the most important things patients can do is seek care from a multidisciplinary team that works closely together,” Dr. Nelson says. “Breast cancer treatment often involves coordination between surgical oncology, medical oncology, radiation oncology, genetics, radiology and plastic surgery. Having that collaboration helps ensure patients receive thoughtful, individualized care.” 

She emphasizes that patients should feel comfortable asking questions and taking time to understand their options. 

“This is not a process patients should feel they have to navigate alone,” Dr. Nelson says. “Education and communication are incredibly important parts of breast cancer care.” 

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