Explore This Procedure

About This Program

The Breast Cancer Surgery Program in the Division of Surgical Oncology at Massachusetts General Hospital offers patients highly personalized care in a multidisciplinary setting. Working within the Mass General Cancer Center, our surgeons collaborate closely with a team of physicians to develop treatment plans that meet your individual needs, including:

  • Genetic counselors
  • Medical oncologists
  • Oncology social workers
  • Pathologists
  • Plastic/reconstructive surgeons
  • Radiation oncologist
  • Radiologists

Our surgeons are breast cancer specialists who have undergone additional specialty training in oncology and offer the highest degree of specialization and expertise. Surgery for breast cancer may be complex, and published data have shown that hospitals and surgeons with the highest volume experience with specific operations have better outcomes. Recognizing the relationship between frequency of performing an operation and the quality of outcomes, each breast surgeon in the Division of Surgical Oncology focuses his or her clinical practice on the management of patients with breast diseases. This specialization allows us to offer state-of-the-art breast cancer surgery and provide access to the latest developments in surgical techniques.

In addition to performing surgical biopsies and breast cancer surgery, we collaborate closely with genetic counselors in the Center for Cancer Risk Assessment to evaluate hereditary risk in young patients and patients with strong family histories of breast cancer. Mass General’s breast surgeons are national leaders in offering nipple-sparing mastectomies for patients who wish to reduce their risk of breast cancer due to a genetic predisposition. A wide variety of educational and support services are available for women and their families as they go through diagnosis, decision-making, treatment and recovery. We are committed to providing expertise and compassionate care throughout all stages of your breast health.

Multidisciplinary Approach, Comprehensive Care

Patients come to us with either an abnormal mammogram or a lump that can be felt. During an initial consultation with a Mass General surgeon, patients may also meet with a breast radiologist as part of a multi-clinic review. Our physicians will review your imaging and medical history in addition to conducting a physical examination.

If you have been diagnosed with breast cancer, your multidisciplinary consultation will include meeting with physicians in medical oncology and radiation oncology. This multidisciplinary approach ensures that you receive a comprehensive assessment. That assessment will enable us to recommend treatment options that address your individual needs.

Research

In addition to seeing patients, surgeons within our division also conduct breast cancer research. Your surgeon will be able to tell you about opportunities to participate in one of our research studies or clinical trials.

Learn more about research at the Cancer Center

Mass General Difference

Mass General is consistently ranked among the best hospitals in the country by U.S. News & World Report. Our ranking is based on our quality of care, patient safety and reputation in more than a dozen clinical specialties. Our commitment to excellence means that we work to ensure that you receive the best care at all points during your visit.

As an academic medical center, Mass General invests in research to understand diseases and develop new approaches in treatment. Our doctors are leaders within their respective fields, and collaborate with colleagues in various departments across the hospital. As a patient, you benefit from shared expertise, leading research, and our commitment to quality and excellence.

Evaluation

Patients with a breast abnormality are evaluated at the Mass General Cancer Center in a comprehensive, multidisciplinary clinic. Patients meet with both an experienced breast surgeon and a breast radiologist. Breast radiologists specialize in mammography, ultrasound and magnetic resonance imaging (MRI). Patients are evaluated for abnormalities including:

  • Abnormal mammograms
  • Breast lumps
  • Nipple discharge

After an evaluation, additional diagnostic breast procedures are sometimes required, including:

  • Core biopsies, similar to fine needle aspirations but a slightly larger needle is used. The area is numbed with a topical anesthetic, and the patient is awake during the procedure
  • Fine needle aspiration, in which a thin needle is inserted into the breast to withdraw a small amount of tissue for analysis. The area is numbed with a topical anesthetic, and the patient is awake during the procedure
  • Needle-localized breast biopsies, in which a surgeon uses a small piece of wire to guide removal of abnormal breast tissue. The area is numbed with a topical anesthetic, and the patient is awake during the procedure
  • Open breast biopsies, in which a breast surgeon removes a lump for analysis. This is performed in an operating room with expert anesthesiologists
  • Stereotactic and ultrasound-guided biopsies, where imaging technology is used to guide the biopsy. The area is numbed with a topical anesthetic, and the patient is awake during the procedure

Patients with newly diagnosed breast cancer are also evaluated in multidisciplinary sessions at the Mass General Cancer Center, where the patient can meet with a surgeon, radiation oncologist and medical oncologist, have mammograms and pathology slides reviewed, and receive definitive treatment recommendations in a single visit.

Pioneering Techniques

The majority of our patients with breast cancer undergo lumpectomies and minimally invasive sentinel node biopsies, returning to full activity within a week.

Our surgeons use sentinel node biopsies to assess the axillary lymph nodes and are pioneers in this technique. Axillary lymph nodes are located right under the arm and are important in determining if breast cancer has spread. During a sentinel node biopsy, a blue dye is injected near the tumor to identify the location of the first axillary lymph nodes. One or more lymph nodes are then removed to determine whether the tumor has spread.

Compared to traditional axillary lymph node dissection, sentinel node biopsies reduce the risk of lymphedema and chronic shoulder and arm problems after breast cancer surgery. Lymphedema occurs when removal of a lymph node leads to a build-up of lymphatic fluid, causing the arm and hand to swell. Some patients with small tumors are offered the option of a partial breast irradiation, which is a shortened course of radiation lasting one or two weeks rather than the standard six-to-seven week treatment.

For patients who require mastectomy, our breast surgeons have pioneered nipple-sparing mastectomies. These surgeries are offered to patients diagnosed with a breast cancer or those who are at high risk for breast cancer due to a genetic abnormality. Patients who choose this operation are cared for by a multidisciplinary team that includes breast surgeons from the division of surgical oncology, reconstructive surgeons from the division of plastic surgery and anesthesiologists who specialize in block anesthesia to provide optimal pain control around the time of the operation.

Types of Breast Cancer Surgeries

Lumpectomies

Performed to completely remove the tumor and leave a cosmetically pleasing result. Our surgeons are actively researching novel techniques to perform more directed tumor removal to reduce the need for a second operation.

Mastectomies

Performed when the tumor occupies more than one portion of the breast or when a patient has a strong risk of a second breast cancer. There are several types:

  • Skin-sparing mastectomy, in which the breast skin is kept intact
  • Nipple-sparing mastectomy, in which the nipple and areola remain. Our surgeons are pioneers in this technique and have demonstrated that this operation may be performed after radiation, after previous breast surgery or after cosmetic breast surgery
Sentinel Node Biopsy

A minimally invasive procedure where a dye is used during surgery to determine location of the first axillary lymph nodes. A lymph node, or several, are then removed to determine whether the tumor has spread.

Patient Experience

Your care team will contact you prior to your surgery with preoperative instructions specific to your treatment program. These instructions will tell you how to manage any medication that you are currently taking and let you know if you need to have any preoperative blood work or imaging.

The day of surgery varies depending on the type of surgery needed. Your nurse will review with you what to expect ahead of time.

After Surgery

Our surgeons are invested in providing support to our patients during their active treatment and beyond. Patients are typically screened on a yearly basis for recurrent breast cancer with a clinical breast exam, tomosynthesis or a 3D mammogram, and in special circumstances, a breast MRI. In addition, patients may:

You will receive a phone call from your surgeon approximately seven to 10 days after your surgery with pathology results. These results will determine the next steps in your treatment program and your surgeon will arrange follow-up appointments with other providers if necessary.

Breast Cancer Risk

In addition to performing surgical biopsies and breast cancer surgery, we collaborate closely with the genetic counselors in the Center for Cancer Risk Assessment to evaluate hereditary risk in young patients and patients with strong family histories of breast cancer.

Patients may be at increased risk of developing cancer if they have:

  • A strong family history of the disease, defined as:
    • Breast cancer occurs in a man in the family
    • Breast or ovarian cancer is observed at a young age (such as in the 20s or 30s)
    • Multiple cancers occur in a single individual (breast cancer on both sides or breast and ovarian cancer in a single individual)
    • Multiple women have breast or ovarian cancer
  • Pathologic diagnosis from prior biopsies such as:
    • Atypical ductal hyperplasia, a benign disease where cells are not like normal cells
    • Lobular carcinoma in situ, also a benign disease caused by abnormal cells in the breast

If a family has any or all of these characteristics, consultation in the Center for Cancer Risk Assessment may be appropriate to determine the level of hereditary risk. Management often includes a more intensive screening schedule, which may include initiating mammographic screening at a younger age or adding breast MRI to yearly screening. Earlier medications, such as tamoxifen, which blocks estrogen production, are available and may decrease the risk of breast cancer.

Women who have been diagnosed with atypical hyperplasia or lobular carcinoma in situ are known to be at higher risk of breast cancer, regardless of their family history. These patients are followed more closely and are often advised to take tamoxifen to help decrease their risk of breast cancer. A woman with a strong family history, atypical hyperplasia or lobular carcinoma in situ are evaluated to determine their level of risk and to make management recommendations.

Experts in Prophylactic Mastectomy

Some women who are at an increased risk for breast cancer due to a genetic mutation may ultimately choose to undergo risk-reducing surgery or bilateral prophylactic mastectomy, which is the removal of both breasts. Breast surgeons in the Division of Surgical Oncology are experts in this operation and specialize in preserving the nipple-areolar complex at the time of prophylactic mastectomy. Patients who choose this operation are cared for by a multidisciplinary team, which includes breast surgeons from the Division of Surgical Oncology, reconstructive surgeons from the Division of Plastic Surgery and anesthesiologists who specialize in block anesthesia to provide optimal pain control around the time of the operation. Breast surgeons in the Division of Surgical Oncology have been leaders in developing surgical techniques for nipple-sparing mastectomy and research associated with the safety of nipple-sparing mastectomy.


Patient Resources

Below are additional resources about the Breast Cancer Surgery Program.

How Surgical Oncology Works

How Surgical Oncology Works

Frequently asked questions about cancer surgery

Appointment Scheduling FAQs

Appointment Scheduling FAQs

Frequently asked questions about scheduling an appointment at Mass General Hospital

Patient Experience FAQ

Patient Experience FAQ

Frequently asked questions about the Mass General Hospital patient experience

The Center for Breast Cancer

The Center for Breast Cancer

The Center for Breast Cancer provides comprehensive, compassionate care

Lymphedema Treatments

Lymphedema Treatments

Lymphedema screening for women who have been treated for breast cancer

Cancer Genetics

Cancer Genetics

The Center for Cancer Risk Assessment provides genetic counseling and testing services