Your Guide to Breast Cancer Surgery

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Breast Cancer Surgery

Breast cancer surgery is a form of breast cancer treatment involving the removal of the tumour through an operation. Surgery can be performed as a standalone treatment or in conjunction with other treatments such as radiotherapy and chemotherapy.

Breast cancer surgery may also be an option for those with a significant risk of breast cancer (such as those with BRCA1 or BRCA2 gene mutation) to reduce the chance of cancer from developing in the future.

There are several types of breast cancer surgery, but which procedure is suited for you depends on many different factors that your doctor will advise you on.

 

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Lumpectomy

  • Lumpectomy is the removal of a portion of the cancerous tissue from the breast that aims to preserve as much of the healthy breast tissue as possible.
  • Also known as breast-conserving surgery.
  • Radiotherapy is usually administered as an additional treatment.

Mastectomy

  • Mastectomy is the removal of the entire breast.
  • In some cases, both breasts are removed. This is known as a double mastectomy.
  • You may have small plastic tubes (drainage tubes) inserted into the area where the breast was removed. The tubes are attached to a small bag (drainage bag) to drain fluids and will be removed after a few days.
  • Breast reconstruction surgery can be done at the same time during mastectomy or at a later date.
Comparison & Details
Removed area Lumpectomy: Portion of breast
Mastectomy: Entire breast(s)
Additional surgery Lumpectomy: Reexcision of margin if margin is not clear
Mastectomy: May include reconstructive surgery
Recovery Lumpectomy: Average between a few days to 2 weeks
Mastectomy: Average between 4-8 weeks
Radiotherapy Lumpectomy: Recommended
Mastectomy: Not recommended unless lymph nodes are involved
Based on tumour biology and staging
Length of stay in hospital Lumpectomy: 1-2 days
Mastectomy: 3-5 days

Removal of axillary lymph nodes

  • Breast cancer usually spreads to the lymph nodes in the armpit first. To determine the stage of the cancer, few lymph nodes are removed and examined in the lab.
  • Patient will be advised for SLNB or ALND.
  • Sentinel lymph node biopsy (SLNB) is a minimally invasive procedure to remove the sentinel or main lymph nodes. These are the few lymph nodes where cancer is most likely to spread. SLNB is suitable for patient who has no lymph node involvement on imaging study. By removing only a few lymph nodes, the risk of lymphoedema is reduced.
  • Axillary lymph node dissection (ALND) is a procedure to remove most lymph nodes in the underarm when the cancer already spread to the axillary lymph nodes.

Breast Reconstruction Surgery

  • Breast reconstruction surgery is a procedure to restore the breast's appearance after surgery.
  • There are 2 main types of breast reconstruction surgery — implant reconstruction and tissue (flap) reconstruction. Implant reconstruction uses either silicone gel or saline (salt water) to reshape the breast, while flap reconstruction uses tissue from other parts of the body.
  • Breast reconstruction can be performed at the same time as the breast surgery (immediate reconstruction) or at another time in the future (delayed reconstruction).
  • It is recommended to discuss breast reconstruction with your doctor if you are considering it prior to your surgery. This lets your doctor plan out the ideal treatment plan for you, even if you were to wait and think about breast reconstruction later.

 

Breast cancer surgery is a safe procedure, but there is always a small risk of complications such as:

  • Wound healing issues
  • Pain
  • Bleeding
  • Infection
  • Lymphoedema (arm swelling)
  • Seroma (fluid buildup at operative site)
  • Loss of or altered sensation in the chest, inner arm (from axillary surgery) and reconstructed breasts

Inform your doctor if you experience any of these complications.

Neoadjuvant Therapy

Neoadjuvant therapy is the term for treatment(s) given before surgery is performed. Depending on the characteristics of the tumour, neoadjuvant therapy can also include targeted therapy.

Conventional Treatment Process

Surgery Postoperative Adjuvant Therapy

Neoadjuvant Therapy Process

Neoadjuvant Therapy Surgery Postoperative Adjuvant Therapy

 

Should you undergo Neoadjuvant Therapy?

Generally, when your tumour is too large for surgery or has spread to the lymph nodes, neoadjuvant therapy will be considered. According to international treatment guidelines, the following patients may benefit from neoadjuvant therapy:

  • HER2-positive or triple-negative breast cancer (TNBC) patients
  • Patients with tumour diameter greater than 2cm/lymph node involvement

Neoadjuvant therapy is a better option to achieve therapeutic outcomes. Benefits include better preservation of normal breast tissues and improved survival rates.

Shrinking the Tumour

Neoadjuvant therapy can shrink the tumour before the surgery and increase the chance of breast preservation.

Monitoring Tumour Response

In neoadjuvant therapy, doctors can monitor how the tumour responds to the drugs. The chances of recovery and survival are higher in patients whose tumours disappear completely.

Easier Surgery

Neoadjuvant therapy can reduce the difficulty of the surgery and reduce the risk of surgical complications.

Personalised Care

Depending on the patient's response to neoadjuvant therapy, the doctor can choose a more personalised and effective postoperative adjuvant treatment regimen to reduce the recurrence rate.

Nutrition

Nutrition plays an important role in supporting your recovery journey after breast surgery. 
During this period, your body requires extra nutrients to aid in healing and promote overall 
wellness.


The nutritional needs of people with cancer vary from person to person. As such, your 
cancer care team and dietitian can help to identify your nutrition goal and plan a way to 
achieve your goal, resulting in:

  • Faster recovery
  • More energy
  • Less discomfort and feeling better overall
  • More controlled weight management
  • Reduced risk of infection

For specific dietary instructions and information on the recommended nutritional intake for 
you, be sure to talk to your doctor or dietitian.

 

Dealing with Nausea/Vomiting

⚠️ Managing Post-Surgical Nausea

These symptoms are common after surgery, especially if you've had chemotherapy or radiation.

✓ Helpful Tips to Reduce Nausea:

  • • Smaller, frequent meals: Eat 5-6 small meals instead of 3 large ones
  • • Easy-to-digest foods: Try protein shakes, yogurt, and liquid nutrition drinks
  • • Comforting soups: Simple broths with chicken and vegetables are gentle on the stomach

If nausea persists, consult your healthcare provider about anti-nausea medications.

Exercise

Your cancer care team will guide you on how to perform the proper exercises to aid in your recovery. Exercise is important to help you recover after breast cancer surgery

Exercise Guidelines


1. Start exercising the day after your surgery (unless advised not to by your doctor or physiotherapist)
2. Start the exercise 30 to 40 minutes after taking pain medication
3. Practise deep breathing as often as you exercise
4. Perform the exercises 3 times a day, every day, until you have regained the full range of motion in your arm(s)
5. Perform the exercises daily to avoid forgetting (e.g: exercising after breakfast, lunch and dinner)

Sitting/Supine Exercises

These exercises can be performed while you are sitting on a chair or lying on a bed. When you are not performing these exercises, you may find it more comfortable to rest your arm on a pillow.

1. Hand Squeeze

Make a fist and squeeze slowly, then gently open your fingers out and relax.

2. Wrist Exercise

Support your elbow on a pillow. Keep your hand relaxed and your arm by your side then bend your wrist back and forth.

3. Shoulder Rolls

Lift your shoulder up slowly towards your ears and roll them backwards.

4. Elbow Stretch

Bend your elbow and touch your shoulder with your hand. Then, straighten your elbow completely.

Standing Exercises

These exercises strengthen your arm and ease the tightness in your chest and shoulder muscles. When done regularly, you will gradually regain the normal range of movement of your shoulder(s).

1. Arm Stretch

Clasp your hands together in front of your chest, keeping your elbow in. Using your stronger arm to help, stretch both arms until your elbows are straight out in front at shoulder height then return your arms to your chest. Pull your shoulder blades back as you pull your elbows back.

2. Arm Lift

Keep pushing your hands together so that they support each other as you lift your arms over your head. Continue the support as you lower your hands back towards your hips.

3. Hands on Head

Take your hands, still clasped together, to the top of your head. Slowly and gently bring your elbows together and then stretch your elbows backwards. Be aware of pulling your shoulders back towards the bed but do not extend your neck forward. At first, this exercise will be easier if you lie down. Hold for 5-10 seconds.

4. Hands behind Neck

With your head upright and hands clasped behind your neck, stretch your elbows backward. Hold for 5-10 seconds and stretch the muscles on your chest wall. Avoid bending your upper body while performing this exercise. You can rest in this position, but make sure to relax your chest muscles. This will help stretch scar tissue and assist with arm drainage.

5. Wall Crawl

Stand facing the wall with your toes about 20-25 cm from the wall. Place both hands on the wall at elbow height. Use your fingers to crawl up the wall, going as far as you can. Slowly slide your hands back down the wall and relax. Mark this spot with tape to see how you're doing.

6. Towel Stretch

Get a light bath towel or sheet. Hold one end with the good hand over the top of the shoulder and the other end with the hand of the operated side at hip level behind your back. Using a 'pulley' motion, raise the towel as far as you can across your back (like you are toweling your back dry). Rest for 5 seconds then repeat.

Post-Recovery Exercises


Once you have recovered from your surgery, you are free to do most light exercises that 
do not put weight on your arms. Start with brisk walking or riding a stationary bike 
without leaning on your arms. Other exercises that do not require you to strain your arms 
include tai chi, qigong and gentle yoga.
 

During the first 6 weeks after breast surgery, it is safe to do light housework, but only for 
short periods at a time and with rest in between. Heavier activities can be done after 6 
weeks, unless advised otherwise by your doctor or physiotherapist.

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