Guide to Breast Surgeries & Procedures

Reviewed by the physicians of Columbia’s Surgical Breast Team, December 2023

Learn more below about the different types of surgical operations so you can understand your options and know what to expect from each.

Key Info

Surgery is one of the primary methods of diagnosing and treating breast cancer.
Needing a biopsy does not mean you have cancer. About 80 percent of biopsy results show no cancerous cells.
A range of surgical options exist to meet the needs of patients who have a diagnosis from benign tumors through advanced stage cancer.

Biopsy

A biopsy is a diagnostic procedure, which means it helps identify the characteristics of a lump or other abnormality that was found during a clinical screening or imaging test. Biopsies involve the removal of a small amount of tissue, which is then examined by a pathologist for signs and traits of cancer. It is a common and usually simple procedure.

There are several different types of biopsies:

Fine needle aspiration biopsy: A thin, hollow needle is used to remove a sample of cells. This is the least invasive form of biopsy and usually leaves no scar.
Core needle biopsy: A slightly larger needle is used to remove a sample of cells. It is usually inserted three to six times. This procedure typically does not leave a scar.
Incisional biopsy: A surgeon uses a scalpel to remove a portion of the suspicious tissue. This procedure is often used when a needle biopsy is inconclusive.
Excisional biopsy: A surgeon uses a scalpel to remove the entire area of suspicious breast tissue, as well as some additional surrounding tissue. This is the most invasive form of biopsy.

Needing a biopsy does not mean you have breast cancer. In fact, the majority of biopsy results (about 80 percent) show no cancerous cells.

Intraductal Papillomectomy

This procedure treats benign (non-cancerous) tumors called papillomas that are growing in one or more milk ducts and that can produce an unpleasant nipple discharge.

Traditionally, intraductal papillomectomies have involved the removal of the milk ducts under the nipple, which can cause scarring and other deformities. However, minimally invasive techniques are now available that produce little to no scarring. Ductoscopically guided microductectomy, for instance, allows surgeons to target a specific portion of the milk duct, then remove the papilloma through the nipple itself. This involves no surgical incisions.

Learn more about intraductal papillomas here.

Lumpectomy

Also known as “breast-conserving” surgery, a lumpectomy is a procedure that removes a tumor and a portion of the surrounding breast tissue. The remaining breast tissue is spared. However, the total amount of tissue that is removed ultimately depends on the size of the tumor and how far it has spread. For more advanced cancers, a mastectomy may be recommended.

After getting a lumpectomy, it’s common to undergo several weeks of radiation therapy. This is to eliminate any cancer cells in the remaining breast tissue. Learn more about radiation therapy.

Mastectomy

A mastectomy is a procedure that removes the entire breast. Depending on the type and extent of the breast cancer, there are several different forms of mastectomies:

Simple or total mastectomy: The entire breast is removed, but the underlying muscles are preserved.
Modified radical mastectomy: The entire breast and many of the axillary lymph nodes are removed, but the underlying muscles are preserved.
Radical mastectomy: The entire breast, all of the axillary lymph nodes, and the underlying muscles are removed. This is the most extensive form of mastectomy.
Skin-sparing mastectomy: The entire breast is removed, but as much skin as possible is preserved. The nipple and areola are removed.
Nipple-sparing mastectomy: The entire breast is removed, but as much skin as possible is preserved, including the nipple and areola.

Mastectomies are often the best treatment for advanced staged breast cancer. However, if the cancer has spread to the lymph nodes, radiation therapy and/or additional surgery may also be recommended.

Lymph Node Removal

Lymph nodes are part of the lymphatic system, which filters out disease and waste within the body. But if cancer cells migrate to this system, they can spread more easily. This is why it is important to remove any lymph nodes where cancer has been detected.

During a lumpectomy or mastectomy, doctors will often remove some lymph nodes and send them to a pathologist for examination. If they detect any signs of cancer, further surgery may be needed.

There are two forms of lymph node removal:

Axillary lymph node dissection: This procedure removes the lymph nodes located under the arm. Usually, between five and 30 lymph nodes will be removed.
Sentinel lymph node dissection: This procedure is a less invasive alternative to an axillary lymph node dissection. Instead of removing a large number of lymph nodes, it focuses on the first lymph node (the “sentinel”) that receives lymphatic fluid from the breast. If it does not contain evidence of cancer, then other nodes are also likely clean. This procedure is most appropriate for women with small breast cancers (i.e., tumors less than 5 centimeters).

After receiving a lymph node dissection (especially an axillary dissection) the risk of developing lymphedema can increase. This condition causes swelling due to the build up of lymphatic fluid. However, this risk can be reduced by taking the following precautions after the surgery:

Protect against scrapes, scratches, or anything else that can let bacteria or infection into the body
Avoid extremely high or low temperatures
Avoid excessive pressure or intense exercise
If necessary, lose weight

Next Steps

If you need surgery for breast cancer or another form of breast disease, we’re here for you. Call us now at (212) 305-9676 or fill out our online appointment request form.