If you have early-stage breast cancer (Stage I-III or non-metastatic i.e. which has not spread beyond the breast and armpit) you should be considered for surgery.
If there is increased risk associated with surgery because of your other health issues, there are special decision-making tools which use a number of factors to help your team discuss with you and weigh up the option of surgery.
Breast Cancer Now also have some useful information on surgery here
Type of breast operation
You should be considered for breast conserving surgery, if possible, i.e. removing only the section of breast containing tumour rather than the whole breast (mastectomy). This may include the use of plastic surgical approaches or sometimes neoadjuvant therapy (drug treatment before surgery to reduce the tumour before operating). If plastic surgical input is appropriate but not available locally then you may be referred to another hospital where this is available.
A further operation may sometimes be necessary if the tumour comes close to the edges of the area where the surgeon performed the original operation.
You will usually require a sample to be taken (biopsy) of the lymph nodes in the armpit (axilla) to fully stage the cancer and determine appropriate treatment. Sometimes this will be a technical guided biopsy of the ‘sentinel’ lymph nodes which are at a specific position within the axilla, and these can indicate the likelihood of the cancer having spread into the lymph nodes.
If you are found to have tumour cells within the lymph node/s on a pre-operative biopsy then an axillary ‘clearance’ may be considered. This involves surgically removing all the lymph nodes in the axilla.
If you have had neoadjuvant chemotherapy to reduce the tumour pre-operatively but did not have proven lymph node involvement at initial diagnosis, then at a minimum you should have a sentinel lymph node biopsy. With a good response to neoadjuvant treatment, it may be possible to remove just some of the axillary nodes (targeted) but if there is not a good response to neoadjuvant treatment then a full axillary clearance of all nodes may be required.
If you have Ductal carcinoma in situ (DCIS) this means cells in the lining of the ducts of breast tissue which have started to turn into cancer cells but are still contained within the ducts. If you have DCIS and are having breast conserving surgery, axillary surgery is not recommended but axillary surgery is usually performed if a mastectomy is being done.
Breast Reconstruction
If you are having a mastectomy, breast reconstruction should be discussed either as an immediate option at the time of the initial operation or delayed until a later date, possibly after completion of cancer treatment. If adjuvant radiotherapy is required after mastectomy this will complicate healing if an implant reconstruction has been performed and you should be informed of this potential risk.
You should have access to all reconstructive surgical techniques and pathways. If not available locally then support through a referral to other centres can be placed if required so that geography does not determine access to surgery.