A breast cancer diagnosis can bring uncertainty and difficult decisions, but today’s surgical advances give women more choices than ever before. Depending on tumor and breast size and each person’s individual circumstances, options may range from a lumpectomy and radiation to a mastectomy with advanced reconstruction.

Those choices can feel overwhelming, which is why it matters to have a surgeon who takes the time to explain them. If you have been diagnosed with breast cancer, you can choose the surgeon you want to see without a referral. Schedule a consultation with Dr. Catherine Pesce, an Endeavor Health breast surgeon who can explain your options, answer your questions and help you make a decision that reflects both the science and what matters to you.

How breast cancer surgery has changed

Breast cancer surgery once followed the belief that removing more tissue improved cancer outcomes. Surgeons commonly removed the entire breast, the underlying chest muscle and lymph nodes, resulting in extensive surgery and a long recovery.

Decades of research have changed that approach. For many patients, breast-conserving surgery followed by radiation can yield cancer outcomes comparable to those of mastectomy, allowing surgeons to preserve the chest muscles and much of the breast tissue. Radiation typically begins after the patient has had time to heal from surgery.

Today, we understand much more about the science behind breast cancer and its treatment. That knowledge allows surgeons to focus on safely removing the cancer while preserving healthy tissue when appropriate.

More breast cancer surgery options for women

Two of the main surgical options for breast cancer are lumpectomy with radiation or mastectomy. For many patients, both options can offer similar results in preventing the cancer from returning and improving long-term survival, so other factors often help guide the decision.

Tumor size, breast size and the amount of healthy tissue surrounding the cancer all play a role. A smaller tumor in a larger breast may make breast-conserving surgery easier, while a larger tumor in a smaller breast may require a different approach.

The first priority is always to remove the cancer safely. From there, the conversation can turn to appearance, recovery and what is most important to the individual. The goal is to help each patient make a decision she can feel comfortable with long after treatment ends.

Breast cancer surgery choices are personal

Research has shown that removing additional breast tissue does not automatically lead to better outcomes. Still, the medically appropriate option is not always the choice every patient will make.

For example, someone with a genetic mutation that increases her lifetime breast cancer risk or a strong family history may choose a double mastectomy even if she is eligible for a lumpectomy. For some women, that decision can reduce anxiety and provide greater peace of mind.

A breast surgeon serves as both a medical expert and a patient advocate. We help patients understand the evidence, risks and benefits of each option while also listening to their concerns and priorities. There is no single surgical choice that is right for every woman.

Cosmetic options after breast cancer surgery

Modern breast surgery also places greater emphasis on how the breast will look after cancer removal. At Endeavor Health, breast and plastic surgeons work together to treat the cancer while planning for the best possible cosmetic outcome.

For some women, reconstruction can happen during the same surgery as a mastectomy. Another option is oncoplastic surgery, which combines cancer removal with plastic surgery techniques. A woman with a larger tumor and larger breasts, for example, may be able to have a larger lumpectomy combined with breast reduction.

This approach allows the patient to keep much of her natural breast tissue while reshaping the breast. Radiation may still be needed after surgery, but women who had previously considered breast reduction may be able to address both needs during cancer treatment.

Nipple-sparing mastectomy and breast reconstruction

Advances in mastectomy have also changed what surgeons can preserve. Nipple-sparing procedures can preserve the nipple and breast skin while removing the underlying breast tissue when medically appropriate.

Surgeons can then reconstruct the breast with an implant or the patient’s own tissue. One approach, called DIEP flap reconstruction, uses skin and fat from the lower abdomen to recreate the breast while preserving the abdominal muscles.

These techniques give women options that were not routinely available before. The surgical team can tailor reconstruction to a woman’s anatomy, cancer treatment and personal preferences.

Can sensation be restored after a mastectomy?

One significant challenge remains after mastectomy: loss of breast sensation. Endeavor Health researchers are studying an approach that could help answer whether nerve reconstruction can improve sensation after nipple-sparing mastectomy.

In conjunction with Mark Sisco, MD, division chief of plastic surgery at Endeavor Health, we are leading a clinical trial that uses a nerve graft on one side of the reconstructed breast and compares sensation with the other side over time. We will follow participants long-term to determine how much sensation returns and whether the nerve graft makes a meaningful difference.

The results could help shape future breast reconstruction. If nerve grafting proves effective, it could offer another way to improve quality of life after mastectomy. If it does not provide meaningful benefit, the findings can help patients avoid an unnecessary procedure and associated healthcare costs.

Patients who previously received care at Endeavor Health have generously helped fund this research. Those interested in supporting this trial or similar research can contact Lisa Connelly, director of philanthropy, at the Endeavor Health Foundation for information on philanthropic opportunities.

3D imaging, AI and robotics in breast cancer care

New technologies such as 3D imaging, artificial intelligence (AI) and robotic surgery are starting to play a role in breast cancer care, but many are still in the early stages. AI can already help doctors interpret images and predict breast cancer risk, while 3D imaging continues to advance.

Researchers are also studying robotic surgery for nipple-sparing mastectomies, although it is not currently FDA approved for this use. Early studies show promise, but these procedures require specialized expertise and can take longer to perform.

As these technologies develop, researchers will continue to determine where they can make the greatest difference for patients. The goal is to use technology where it can improve care, save time, reduce costs and lead to better outcomes.

Less invasive surgery can mean an easier recovery

Breast cancer surgery has become less extensive for many women, which can lead to a faster recovery and fewer complications. One of the biggest changes is how surgeons handle the lymph nodes under the arm.

In the past, surgeons often removed all of these lymph nodes. Today, some patients may need only a few of the first lymph nodes checked for cancer, while certain women with small tumors may not need any lymph nodes removed at all.

Removing fewer lymph nodes can lower the risk of lymphedema, a condition that can cause persistent swelling. It can also reduce numbness and shoulder problems, helping women recover more comfortably and avoid some lasting side effects. 

Better pain control after breast cancer surgery

Most breast cancer surgeries are now outpatient procedures, so patients can often go home the same day. Even some women who have a double mastectomy may not need to stay overnight, depending on their procedure and individual needs.

Doctors can also use a nerve block before surgery to help manage pain. A nerve block uses medication to temporarily numb the nerves in the surgical area, which can reduce pain during and after the procedure. This can make recovery more comfortable and reduce the need for stronger pain medications.

More complex procedures, such as DIEP flap reconstruction, typically require a hospital stay.

More choices. More personalized breast cancer treatment.

The evolution of breast cancer surgery has given women something especially valuable: choices. At Endeavor Health, breast surgeons and plastic surgeons bring their expertise together to personalize care, considering not only how to safely remove the cancer but also recovery, breast appearance, sensation and what matters most to each patient. If you are facing a breast cancer diagnosis, schedule a consultation with Dr. Catherine Pesce to talk with an Endeavor Health breast surgeon and plastic surgeon to understand your options and find the approach that feels right for you.