Frequently Asked Questions from Patients Undergoing Breast Surgery
What surgery should I have, breast conserving-surgery or mastectomy? How does my choice of breast-conserving surgery rather than mastectomy affect my chances of surviving breast cancer?
For many women, the decision for breast-conserving surgery rather than mastectomy (removal of all of the breast tissue) is a personal choice. Your surgeon will tell you if there a reason why you may not be a good candidate for either of the procedures. In most cases, survival is the same between mastectomy and breast-conserving surgery. However, there may be a slightly higher risk of the cancer coming back in the breast after breast-conserving surgery.
Some things women consider when deciding what type of surgery to have include:
- How strongly do I want to preserve my breast?
- How important is my breast to my sense of body image?
- How important is my breast to my sexuality?
- How much would I worry about having cancer come back in the breast?
- How do I feel about receiving radiation?
Does my choice of surgery (breast-conserving surgery or mastectomy) affect other treatment I will need (chemotherapy, endocrine therapy or radiation therapy)?
When we think about breast cancer treatments, we consider treatments that are "local-regional" (the breast and the lymph nodes) rather than "systemic" (treating the whole body). Treatments that are local-regional include surgery and radiation, and the treatments that are systemic include chemotherapy and endocrine therapy. In general, the type of local-regional treatment you have does not affect the type of systemic treatment you undergo. For example, the type of breast surgery you have will not affect whether you are recommended to have chemotherapy or endocrine therapy. However, the type of surgery you undergo would influence the likelihood of receiving other local-regional therapy such as radiation.
If I have cancer diagnosed in only one breast and am considering having a mastectomy, do I need to have both breasts removed (bilateral mastectomy)?
We do not think that removing the non-affected breast improves survival from a woman’s cancer. However, women with a personal history of breast cancer are at higher than average risk of developing a new breast cancer in the future and removing the opposite breast would decrease this risk. In general, though, if a woman does not have a strong family history of known genetic mutation, the risk of developing a new breast cancer is still relatively low. The best estimates we have are 0.25 percent to 0.5 percent per year. This translates into a 5 percent to 10 percent risk over 20 years and a 10 percent to 20 percent risk over 40 years.
We do not recommend a bilateral mastectomy for most women. However, women with a strong family history or very young patients may consider it. Some women may consider it for symmetry after a mastectomy.
Will I have drains in place following my surgery, and if so, how long will they need to stay in?
If you have mastectomy surgery, there will be drains near your incisions to collect blood and other fluids. They will remain in place for several days to weeks depending on your procedure. While you are in the hospital, our nurses will help you and your family learn how to care for them.
When can I return to all of my normal activities? How long will I need to be off work?
The length of your recovery depends on the type of breast and lymph node surgery you have. Patients having breast-conserving surgery with sentinel lymph node biopsy are feeling almost back to how they were before surgery in about two to three weeks. Women having mastectomy or axillary lymph node dissection have a longer recovery; this is affected by the type of reconstruction (if any) women choose. Ask your breast and plastic surgeons for estimates.
Do I need to worry about developing lymphedema? What steps can I take to prevent lymphedema from occurring?
Lymphedema may develop anytime lymph nodes are removed. The risk is much lower when a sentinel lymph node is performed compared to an axillary lymph node dissection, and it relates to the number of lymph nodes removed. After surgery, you will be provided information about precautions you can take to prevent or manage lymphedema.