Most women who have DCIS or Stage I, IIA, IIB, or IIIA breast cancer have three basic surgery choices. They are 1) breast-sparing surgery followed by radiation therapy, 2) mastectomy, or 3) mastectomy with breast reconstruction surgery.

Breast-Sparing Surgery

Breast-sparing surgery means that the surgeon removes only your cancer and some normal tissue around it. This kind of surgery keeps your breast intact--looking a lot like it did before surgery. Other words for breast-sparing surgery include "lumpectomy," "partial mastectomy," "breast-conserving surgery," or "segmental mastectomy."

After breast-sparing surgery, most women also get radiation therapy. This type of treatment is very important because it could keep cancer from coming back in the same breast. Some women also need chemotherapy and hormone therapy.

Mastectomy

In a mastectomy, the surgeon removes all of your breast and nipple. Sometimes, you will also need to have radiation therapy, chemotherapy, hormone therapy, or all three types of therapy. Here are some types of mastectomy:

• Total (simple) mastectomy. The surgeon removes all of your breast. Sometimes, the surgeon also takes out some of the lymph nodes under your arm.
• Modified radical mastectomy. The surgeon removes all of your breast, many of the lymph nodes under your arm, the lining over your chest muscles, and maybe a small chest muscle.
• Double Mastectomy. The surgeon removes both your breasts at the same time, even if your cancer is in only one breast. This surgery is rare and mostly used when the surgeon feels you have a high risk for getting cancer in the breast that does not have cancer.

Breast Reconstruction Surgery

If you have a mastectomy, you can also choose to have breast reconstruction surgery. This surgery is done by a reconstructive plastic surgeon and gives you a new breast-like shape and nipple. Your surgeon can also add a tattoo that looks like the areola (the dark area around your nipple). Or you may not want any more surgery and prefer to wear a prosthesis (breast-like form) in your bra. There are two types of breast reconstruction surgery:

• Breast implants. In this kind of surgery, a reconstructive plastic surgeon puts an implant (filled with salt water or silicone gel) under your skin or chest muscle to build a new breast-like shape. While this shape looks like a breast, you will have little feeling in it because the nerves have been cut.

  Breast implants do not last a lifetime. If you choose to have an implant, chances are you will need more surgery later on to remove or replace it. Implants can cause problems such as breast hardness, breast pain, and infection. The implant may also break, move, or shift. These problems can happen soon after surgery or years later.

• Tissue flaps. In tissue flap surgery, a surgeon builds a new breast-like shape from muscle, fat, and skin taken from other parts of your body. This new breast-like shape should last the rest of your life.Women who are very thin or obese, smoke, or have other serious health problems often cannot have tissue flap surgery.

  Tissue flap is major surgery. Healing often takes longer after this surgery than if you have breast implants. You may have other problems, as well. For example, you might lose strength in the part of your body where muscle was taken to build a new breast. Or you may get an infection or have trouble healing. Tissue flap surgery is best done by a reconstructive plastic surgeon who has done it many times before.

To learn more about breast reconstruction, see "Resources to Learn More."

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