Surgery
Common Surgeries
Biopsy
Most biopsies are performed as needle procedures so that a surgeon can determine what a finding is without the risks of anesthesia for patients. Learn more about image guided needle biopsies on our Imaging Page.
Excisional Biopsy
Sometimes due to the location of your finding needle biopsy is not always the best option and you may need to go to the OR for definitive tissue diagnosis. You may have also had some atypical cells found on a needle biopsy and your doctor may recommend removing the area to prevent further abnormal cell growth. Most excisional biopsies are performed in an ambulatory surgical center. Your surgeon may need the area localized under imaging guidance first for tissue preservation. You will likely go home the same day.
Nipple Exploration
This is the common practice procedure now to determine the origin of nipple discharge. Discharge can indicate a variety of benign and malignant processes but if you have had clear imaging, your doctor may still need to explore to find out the reason why you are experiencing discharge. This is typically performed in an outpatient surgical setting and you will probably be able to go home the same day.
Lumpectomy
The term "lumpectomy" is reserved for patients with a cancer diagnosis. The process is very similar to that of the excisional biopsy but lumpectomy is performed to remove cancerous lesions. You may need to have the lesion localized by imaging guidance prior to your surgeon operating. Most lumpectomies are same day surgeries where you get to go home after your post operative recovery.
Mastectomy
Mastectomy removes most breast tissue; no operation can guarantee that every breast cell is removed. The exact operation depends on the diagnosis, anatomy, cancer risk, lymph-node plan, and reconstruction or flat-closure goals. Total or simple mastectomy removes the breast tissue and usually the nipple-areola complex. Sentinel lymph-node biopsy may be performed as a separate part of the operation when indicated. Skin-sparing mastectomy preserves most of the breast skin for reconstruction while removing the breast tissue and usually the nipple-areola complex. Nipple-sparing mastectomy preserves the skin and nipple-areola complex while removing underlying breast tissue. The nipple is generally preserved in place—not removed and reattached—and tissue beneath it may be evaluated. Modified radical mastectomy removes the breast and a group of underarm lymph nodes. Radical mastectomy also removes chest-wall muscle and is now rarely needed. A mastectomy may be unilateral or bilateral and may be performed for cancer treatment or risk reduction. Options may include reconstruction, an aesthetic flat closure, or no reconstruction. Ask what tissue and lymph nodes will be removed, how sensation may change, what pathology will be performed, and what future examination or imaging is recommended.
Top Surgery
Top surgery is an umbrella term for gender-affirming surgery that changes the shape or size of the chest or breasts. Transgender, nonbinary, gender-diverse, and cisgender people may seek these procedures; the right language and goals belong to the individual. Chest masculinization or chest reconstruction is not simply the same as an oncologic mastectomy. Techniques may include double-incision surgery with or without nipple grafts, periareolar or keyhole approaches, and contouring. The amount and location of remaining tissue vary. Chest feminization or breast augmentation may use implants, fat grafting, or both. Implant placement, size, future imaging, and long-term implant monitoring should be discussed with the surgeon. These procedures are commonly performed by plastic or reconstructive surgeons with gender-affirming expertise. Removed tissue may be sent for pathology according to the surgeon’s and facility’s practice and the individual’s history. Before surgery, discuss scars, nipple preservation or grafting, sensation, drains, recovery support, potential revisions, future lactation goals, family or personal cancer risk, and what breast/chest screening may be appropriate afterward. Gender-affirming surgery changes anatomy but does not automatically reduce cancer risk to zero.
Reduction
Breast reduction removes skin, fat, and glandular tissue to reduce breast size or weight and reshape the chest according to the individual’s goals. People may seek reduction for neck, back, or shoulder discomfort; bra-strap grooves; skin irritation; difficulty with movement or clothing; body-image concerns; or gender dysphoria. “Natural” does not describe one correct breast shape or size. Discuss scar placement, nipple position, possible changes in nipple sensation, asymmetry, wound-healing risks, and how the procedure may affect future lactation. Coverage varies: some insurance plans require documentation of symptoms, prior treatments, or an estimated amount of tissue removal, while others exclude the procedure. Ask the surgeon’s office and insurer about the specific requirements before scheduling.
Augmentation
Augmentation is one of the most common breast surgeries performed. It involves the reshaping and resizing of breasts, typically with implant placement. Implants can be placed in front of the muscle or behind the muscle. Implants are made of either saline or silicone and your plastic surgeon will have samples and sizes for you to explore prior to surgery.
Reconstruction
Reconstruction is optional. Choices may include implant-based reconstruction, tissue-flap reconstruction using the abdomen, back, thigh, or another donor site, a combination of methods, oncoplastic reshaping, fat grafting, or an aesthetic flat closure. Reconstruction may be immediate, delayed, or completed in stages. The cancer operation, radiation plan, prior surgeries, health conditions, healing risk, recovery time, available donor tissue, and personal goals all affect which options are appropriate. Reconstruction often involves more than one operation, and revisions may be medically appropriate, but no surgeon or insurance plan can promise unlimited procedures or a particular cosmetic result. Ask about sensation, scars, symmetry, implant lifespan or monitoring, flap risks, recovery support, and how future cancer surveillance will work. Federal and state protections may require certain health plans that cover mastectomy to also cover breast reconstruction, treatment of complications, and procedures on the other breast for symmetry. Coverage, authorization, networks, and out-of-pocket costs still vary, so confirm the details with the insurer and surgical team. Choosing no reconstruction is also a valid option.
ASK!
Ask your surgeon any and all the questions you can think of at your pre-operative visit.
At the time of consent, if you have any remaining questions, ask those too!
FOllow instructions
You are likely to receive pre-operative instructions. They are given to you for your safety. Please read through, get clarification if you need it and follow those instructions so your surgery can be performed as planned.
Participate
You may be involved with the time out process, which is used to verify that you are the correct person, the correct surgery on the correct body part is being performed, and the care team is aware of your allergies. If you are involved speak up if something is wrong.
Plan Ahead
Be prepared for your post operative needs. This may mean having someone around to help you care for your household needs, driving you to visits, etc.
If you know you will need pain management after make sure you have made advance arrangements.