Breast Surgery for Cancer



  • Also called a partial mastectomy (or “breast conservation therapy when combined with

  • This removes the tumor and a small margin of healthy tissue around it.

  • A localization device is used to find the clip placed during your biopsy (the area that needs to be removed)

    • Magseed – a small magnetic “seed” placed with a needle by
      radiology at any time prior to your surgery at a separate appointment.

    • Wire localization – The morning of surgery, radiology will place a wire through a
      needle poke, which will be sticking out of your breast. This will guide the
      surgeon to the correct place during surgery.

  • One small incision on the breast

  • Specimen is marked for orientation and sent for mammogram to ensure clip and lesion
    are removed. Then it is sent to pathology for further analysis

  • Same day surgery

  • Final pathology takes 2-4 days to return, you will be called with results

  • Risks

    • Fluid collection (seroma, hematoma)

    • Infection

    • Need for further surgery (margins, lymph nodes)

    • Pain

    • Anesthesia-related risks (heart, lung complications and blood clots)

  • Results

    • Superior cosmetic results

    • Increased chance of local recurrence compared to mastectomy

    • Equal or improved overall survival

    • Will need to be followed with mammograms and physical exams



  • Removal of your entire breast
  • You can choose to not undergo reconstruction, and will have a flat scar
  • You may choose to have reconstruction
    • You will be recommended to meet with a plastic surgeon (often preoperatively) to discuss plans for reconstruction, which can affect your type of mastectomy
      • If planning reconstruction, a skin-sparing, or nipple-sparing surgery may be offered, which can improve cosmetics
  • One larger incision o Entire breast is removed off the underlying muscle.
  • A drain is left in this space to collect the fluid that will accumulate until this scars down
  • The skin is closed
  • Overnight stay
  • You will go home the following day with drain in place for a couple weeks
  • You will be taught how to care for the drains, empty and record outputs (see below)
  • Risks
    • Bleeding
    • Fluid collection (seroma, hematoma)
    • Infection
    • Need for further surgery less common
    • Pain
    • Cosmetic issues
    • Anesthesia-related risks (heart, lung complications and blood clots)
  • Results
    • Decreased chance (but not 0%) of local recurrence compared to lumpectomy as the breast tissue has been removed
    • Will need to be followed with physical exams as you will be unable to have a mammogram after a mastectomy


Sentinel Node Biopsy

  • This is done for “staging” for invasive cancer
  • A few lymph nodes are removed, so the pathologist can look at the under the microscope to determine if the cancer has spread here
  • This surgery was developed to prevent the unnecessary removal of large numbers of lymph nodes that aren’t involved by the cancer.
  • To identify the sentinel lymph node, doctors inject a tracer that accumulates in the first lymph node(s) that cancer would spread to.
    • Magtrace – magnetic, injected 1-3 weeks before surgery by a radiologist
    • Radioactive tracer and blue dye – injected the morning of surgery, and during your surgery while you are asleep
    • Small incision in the axilla (armpit), or done through a standard mastectomy incision
  • A probe is used to identify the sentinel lymph nodes by locating the tracer that has accumulated in these nodes
  • Everyone is different, but most people have 1-4 sentinel lymph nodes
  • These are completely removed to send to pathology
  • A sentinel lymph node biopsy can be done with either a lumpectomy or a mastectomy and is often performed at the same time as your breast surgery
  • Pathology results will take 2-4 days to result
  • Risks
    • Bleeding, infection, Injury to surrounding structures
    • Fluid collection (seroma, hematoma)
    • Need for further surgery or treatments if there is cancer present in the lymph nodes
    • Minimal risk of lymphedema (arm swelling)
    • Anesthesia-related risks (heart, lung complications and blood clots)

Axillary lymph node dissection

  • If multiple lymph nodes are involved by the cancer, an axillary lymph node dissection may be done to remove them. This means removing many of the lymph nodes under your arm (your axilla)
  • This has a higher rate of lymphedema (swelling in the arm), so you will be referred to a physical therapist after surgery to help manage this if it occurs.
  • Steps
    • Incision in the axilla (armpit)
    • Dissection of lymph nodes to remove them from the
      surrounding tissue/nerves/vessels
    • Removal of level 1 and 2 nodes
    • Possible drain placement, skin closure
  • Risks
    • Bleeding, infection, injury to surrounding structures
    • Fluid collection (seroma, hematoma)
    • Increased risk of lymphedema (arm swelling) – 20-
    • Anesthesia-related risks (heart, lung complications and blood clots)

What to expect

Preparing for your surgery

  • Nothing to eat or drink after midnight the night before your surgery
  • You may take am meds (you will be told which ones to take/hold) with a sip of water in the am
  • If you smoke; quitting smoking before surgery can decrease your risk of respiratory complications and infections after surgery.
  • You may need localization (wire, Magseed) and/or tracer injection
    • This is scheduled for you prior to surgery as a separate procedure. It may be done weeks ahead of time, or on the day of surgery.

Day of Surgery

  • You may receive general anesthesia and have a breathing tube (endotracheal tube) put down during surgery. You will be completely asleep and the tube is removed before you wake up.
  • You may have a lighter anesthetic if your cancer is small and your anesthesia provider feels this is safe. The anesthesia provider will meet with you the morning of surgery
  • Most people go home within a few hours after surgery, unless you are having a mastectomy
  • You will need someone to drive you home and be close for the first night following your surgery
  • Surgery Locations
    • Brightside Surgical
      • 401 N. 9th Street Bismarck, ND 58501
        North side of the Essentia/MDC main building
        Enter through door #7
    • CHI St. Alexius
      • 900 East Broadway Bismarck, ND 58501
        Enter through the East Patient Entrance (Door #17)


  • Eat normal diet, start with bland foods. Ensure you are drinking 8-10 glasses of water a day after surgery. Eat high-fiber foods or take fiber supplement (ex. Metamucil) to help with your bowel movements after surgery.
  • If you had a lumpectomy, you will not need narcotics. You may take Tylenol or ibuprofen as needed
  • If you had a mastectomy, you will stay overnight. You will be sent home with pain medications which most people will take for a few days after surgery then are able to wean to non-narcotic mediations
    • Take ibuprofen (unless you have a medical reason not to) in addition to help decrease the amount of narcotic you are taking.
    • Norco (the narcotic most commonly prescribed) has Tylenol in it. Either take norco OR Tylenol in addition to the ibuprofen.
  • Take stool softeners and/or laxatives as needed (docusate, miralax) to help your bowels stay regular following surgery. Anesthesia and pain medications can contribute to constipation postoperatively.
  • Walk around as able. Take deep breaths to fully expand your lungs. This can help prevent pneumonia and blood clots
  • Slowly increase your activity. Your surgeon will let you know if you have any restrictions after your surgery.
  • Most people will be able to return to work or school a few days to a week after a lumpectomy, and 2-4 weeks after a mastectomy
  • Wound care
    • It is expected you will have a fluid collection at the site of your lumpectomy and/or axilla surgery. This will feel hard and round. Your body will slowly absorb this over time, but this takes weeks to months. If you develop sign of infection (fevers, drainage, significant redness please call the office)
    • All sutures used will be buried under the skin and absorbable. o If you have steri strips over your incisions. Remove dressings in 24-48hrs after surgery. Leave white strips (steri strips) in place and shower. Let soapy water run over these and pat dry. They will begin to peel off in about 7-10 days then you may remove.
    • If you have skin glue (dermabond) over the incisions you may shower immediately. When this begins to flake off you may peel off, typically in a week. o Do not bathe, soak incisions, go in hot tube, pool or lake/ocean for 2 weeks.
    • Your scar with heal over the next 4-6 weeks and continue to fade and soften over the next year. Use sunscreen over incisions if exposed to sun for the next year.
  • Drain care
  • Exercise
    • Doing arm and shoulder exercises will help you get back your full range of motion on the affected side
    • These exercises can help keep scar tissue from forming in your armpit and shoulder. Scar tissue can limit your arm movements later.
    • Do these exercises 3 times a day until you can move your affected arm the way you did before surgery. After that, keep doing them once a day. o Start slow and slow increase as you are able.
    • If you still have trouble moving your shoulder 4 weeks after your surgery, tell your surgeon.
  • Massage
    • You may massage your incision with clean hands after 2 weeks. This may help the way it scars.

When to Call

  • Severe or worsening uncontrolled pain
  • A fever >101.3
  • Continuous vomiting
  • Foul smelling drainage, redness or continued bleeding from an incision sites
  • Chest pain or trouble breathing (call 911 or go to the ER)
  • Any questions or concerns

Patient Information & Documents