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 is the complete removal of the breast tissue. There are different types: Simple: removes all the breast tissue and the nipple. Modified Radical: simple plus the removal of lymph nodes. Radical: rarely performed today, involves the removal of the breast tissue, nipple, underlying pectoralis muscle and the lymph nodes - serious stuff. Nipple sparing: removal of breast tissue but the nipple is carefully removed and reattached.
Top Surgery
Gender affirming surgeries that involve either removal of breast tissue or breast augmentation. Normally this is a plastics procedure. If you are transitioning from F to M your tissue may still go to get histologic analysis to make sure there were not atypical or cancerous cells in the removed breast tissue. For F to M patients surgery is a simply mastectomy. For M to F it is an augmentation surgery.
Reduction
Large pendulous breasts can be the source of much discomfort and body image concerns. Breast reduction surgically removes excess fat, glandular tissue and skin from the breast/chest to create a more natural appearance while also alleviating symptoms like: back and neck pain, shoulder grooves from bra straps, chaffing, etc. Some insurance companies consider this to be cosmetic, while others recognize reduction as a medical necessity. Check with your insurance regarding requirements.
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
There are two main types of reconstructive surgeries. Patients can choose to have an implant placed like the augmentation process or have an autologous transplant from another area of their body, such as belly, back or thigh. Sometimes reconstruction utilizes a bit of both. Explore all the options and choose the best fit. If you are having oncoplastic reconstruction you can choose to do this at the time of your cancer surgery or wait until you have healed. If you are being reconstructed due to a personal history of breast cancer or a BRCA mutation, you should be able to continue to have surgeries until you are happy with the cosmetic appearence.
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.