Surgery

Most treatment for breast cancer involves surgery.  The aim of surgery is to remove the cancer cells from your breast.  The kind of surgery you have will depend on your breast cancer. 

Every woman is different and every woman’s treatment plan will be different.  Discuss all your options with your surgeon carefully and don’t feel pressured to make a quick decision.  Ask your surgeon to explain the advantages and disadvantages of all the options available to you. 

On these pages, you’ll find out more about:

 The different types of surgery

Lumpectomy or partial mastectomy

This is sometimes known as breast-conserving surgery and involves the removal of only the cancerous lump and some of the surrounding normal tissue. The amount of tissue removed can vary greatly with this type of surgery. It is usually followed up with radiation therapy.

Mastectomy

A mastectomy involves the removal of the entire breast.  In some cases a mastectomy may be more extensive and involve the removal of lymph nodes under the arm. Depending on your breast cancer and your surgeon it may be possible to have breast reconstruction surgery at the time of a mastectomy, but you may also be able to have this reconstruction surgery performed at a later date if you prefer.  Discuss this option carefully with your surgeon.  In some parts of the country, there can be long waits for reconstruction surgery delayed until after mastectomy.

Removal of lymph nodes

If cancer cells have spread from the breast, the first place they are often found is in the lymph nodes under your arm.  There are two types of surgery to remove the lymph nodes:

  •  axillary lymph node dissection which involves removing all lymph nodes under your arm, including the affected nodes and unaffected nodes, usually at the same time as your mastectomy or lumpectomy. 

  • sentinel node biopsy is  a newer technique and allows your surgeon to identify the first nodes to be affected by cancer.  A small amount of radioactive dye is injected into the tumour site a few hours or a day before your surgery. As this dye drains through the lymphatic system it shows where the cancer cells may have spread to and allows your surgeon to pinpoint the lymph nodes that need to be removed.   

If you have surgery to remove lymph nodes you may be at risk of developing lymphoedema.  Read our section on lymphoedema, for more information. 

Breast reconstruction

This involves recreating the appearance of a breast after a mastectomy.  There are several different reconstruction options, including:

  • Breast implants

  • Latissimus dorsi flap

  • Abdominal tissue reconstruction

Find out more about these on our breast reconstruction page.  Remember, you don’t need to make a decision on breast reconstruction immediately.  Some women decide that reconstruction is the right option for them, while many others choose never to have reconstruction surgery.

Find out more

Types of breast cancer

Not all breast cancers are the same and determining what kind of breast cancer you have will help your medical team to decide what is the most suitable and effective treatment for you. Most treatment for breast cancer involves surgery. During surgery breast tissue is removed and will then be examined by a pathologist who will provide information on the kind of breast cancer you have. 

Below you'll find information on:

Pathology Report

The Pathology Report is put together by the pathologist.  It includes information on the following:

  • your clinical history

  • a description of the tissue type removed e.g. breast or lymph node

  • clinical diagnosis – the initial diagnosis made before your tissue sample was tested

  • gross description – explains the size, shape and appearance of this tissue

  • microscopic description - explains how the cancer cells look under the microscope

  • information on blood and other tests for proteins, genetic components and details about how fast the cells are growing

  • final diagnosis.

Setting the stage

The aim of the pathology report and other tests such as chest x-rays, MRIs, or CT scans is to “set the stage” of your cancer. Setting the stage allows medical staff to determine how advanced or otherwise the cancer is. To determine the stage, the following are taken into account:

  • tumour size

  • whether lymph nodes are involved 

  • whether the cancer has spread beyond the breast and the underarm lymph nodes.

There are several different types of early breast cancer and these are outlined in the table below.

The stages of early breast cancer

Stage 0 Cancer has not spread beyond the ducts of the breast (also known as ductal carcinoma in situ or DCIS).
Stage I Cancer cells are found outside the ducts in normal breast tissue, with tumour size of 20 mm or less and no spread beyond the breast. This is often also called invasive breast cancer.
Stage II

Invasive cancer in which the tumour size is:

- 20mm or less and has spread into a maximum of three underarm lymph nodes on the same side
- over 20mm, but smaller than 50 mm with or without spread to maximum three  underarm lymph nodes  on the same side
- 20-50mm and/or the cancer has spread to the underarm lymph nodes.
Stage III

Tumour size is:

- greater than 50mm and has spread to one to three lymph nodes under the arm;
- smaller than 50 mm but has spread to four or more lymph nodes under the arm;
- any size but with direct extension to the skin of the breast or to underarm lymph nodes the chest wall.

 The stages of metastatic, advanced, or secondary breast cancer, in which cancer has spread to other parts of the body are: 

Stage IIIB Tumour (any size) has spread to skin of breast, chest wall, internal mammary lymph nodes.
Stage IV Tumour has spread beyond breast, underarm, internal mammary nodes to other parts of the body – lungs, liver, bone, brain.

In addition to staging, the cancer will also be given a grade between one and three. The grade indicates how fast your cancer has been growing. Grade 1 is a slow growing cancer, grade 3 is a fast growing cancer and grade 2 is growing at a rate in between grade 1 and 3.

Staging and the cancer grade will help determine the best treatment for you. This is likely to include surgery and may also include chemotherapy, radiation therapy, endocrine therapy and targeted therapy.

Other types of breast cancer:

Lobular Carcinoma in Situ (LCIS) Abnormal cells are found in the lobules of the breast, but are contained to this area. This is NOT invasive breast cancer and does not need to be treated if there are no other changes to the breast. A woman with LCIS is, however, at greater risk of developing breast cancer and should have regular check ups.
Inflammatory breast cancer This is a rare invasive form of the disease. It does not form as a lump, but spreads along the blood vessels in the skin of the breasts causing them to become red, inflamed and dimpled. Treatment should be sought as soon as symptoms are identified.
Paget's disease of the nipple  An invasive form of cancer that affects the nipple and area around the nipple.  It can appear as a crusty rash or eczema around the nipple, or the nipple may be red, inflamed and itchy. Many women with this form of the disease will also have breast cancer somewhere else in the same breast.

HER2 and Hormones

Your pathology report will also include information on hormone receptors and whether your breast cancer is growing in response to the female hormones oestrogen and progesterone.

Below is a summary of the main types of hormonal and genetic breast cancer.  Click on the type of breast cancer for more information:

Oestrogen receptor pPositive Your breast cancer responds to the hormone oestrogen and may grow faster when this hormone is present. Oestrogen blocking agents such as tamoxifen or aromatase inhibitors are prescribed when the cancer is oestrogen receptor positive. 
Progesterone receptor positive Your breast cancer responds to the hormone progesterone and may grow faster when this hormone is present.
HER2-positive Your breast cancer produces more of the HER2 protein which affects how quickly the cancer cells will grow. Medicines such as trastuzumab (Herceptin) are often effective in treating this type of cancer. 
Triple negative breast cancer Your breast cancer is not responsive to oestrogen, progesterone or HER2 proteins and does not respond to medicines that block them. This type of breast cancer behaves aggressively and standard chemotherapy is usually recommended. 
BRCA or BRCA2 Breast Cancer This is a hereditary type of breast cancer which is affected by mutations in the BRCA1 and/or BRCA2 genes. The proteins associated with these genes are involved in the repair of damaged DNA, but in women who have inherited abnormal forms of these genes this repair does not take place allowing cancer cells to grow.  

While chemotherapy can be effective against all these types of breast cancer, there are specific targeted treatments that may be used to treat hormonal breast cancers (e.g. tamoxifen and aromatase inhibitors) and HER2-positive cancers (e.g. Herceptin). Clinical trials are under way to investigate whether novel classes of drugs, such as PARP inhibitors, will be effective in targeting triple negative breast cancers. 

Find out more:

●    Order a copy of Step by Step.
●    Visit our pages on HER2-positive breast cancer.
●    Look at the New Zealand Cancer Society’s booklet on breast cancer. 
●    Check out other useful websites such as www.canceraustralia.gov.au or www.breastcancer.org 

See this Patient Decision Aid for patients who are considering breast cancer treatment with chemotherapy and/or hormonal therapy before surgery (neo-adjuvant therapy).

Breast cancer diagnosis

If you’ve just been diagnosed with breast cancer, you may be feeling a whole lot of things all at once - fear, sorrow, anger, anxiety. It’s normal to feel these emotions and to feel uncertain and scared.

Information can help to reduce your fear of the unknown, but it takes time to absorb. So take some time to review the medical information you’ve been given. Catch your breath, let those emotions work themselves out so that you can take charge, review treatment options and make the decisions that are right for you.

Order one of our Step by Step support packs so that you have all the information you need at your finger tips. Step by Step contains an information book as well as a diary to help you organise appointments and keep track of medical information, and a journal to record your thoughts and feelings.

If you feel like your emotions are overwhelming you check out some of the tips below to keep on an even keel:

  • Slow down and think about what you will need to help you over the next few days, weeks and months.

  • Actively participate in the medical process

  • Find a medical team that you feel comfortable with
  • Write down questions for your medical team
  • Keep asking questions until you understand
  • Take a support person with you to consultations to take notes
  • Seek a second opinion if you want to
  • Don’t rush decisions about your treatment programme
  • Speak to others who have been there – talk to someone with breast cancer who will listen to you
  • Read a book by someone who has had the disease - see our recommended reading page
  • Don’t be afraid to ask for help from friends, family, or support groups
  • Let your feelings out by talking to your partner, a close friend or family member or by writing in a journal
  • Be kind to yourself
  • Focus on your recovery and the healing process.

Find out more

You will also find more information through the following sources:

Diagnostic Tests

Screening tests such as mammograms or ultrasound can only lead doctors to suspect breast cancer. 

To determine if cancer is actually present a doctor will need to take a biopsy of the breast tissue and then examine this tissue under a microscope to see if cancer cells are present.

A biopsy involves a small operation to remove some of the breast tissue. Your doctors will generally try to use the least invasive method possible to minimise scarring.  However, this may not always be possible. 

There are several different kinds of biopsy.  The most common are:

Other tests may also be done to determine whether the cancer has spread to other parts of the body.

These include:

Biopsy Types

Fine Needle Aspiration

With this procedure you will have a local anaesthetic to numb the breast area.  The doctor then uses a very fine hollow needle which is attached to a syringe. The doctor uses an ultrasound image to guide the needle into the lump or area of concern. Breast cells are then sucked up through the syringe and sent to a laboratory for analysis.

Core Needle Biopsy 

This procedure uses a larger hollow needle than Fine Aspiration does and is often used when the lump is solid rather than fluid.

Again your breast will be injected with local anaesthetic. The doctor will make a small cut in the skin of your breast to allow the needle to pass through. The needle is then guided to the area of concern and several samples of tissue are withdrawn. These are sent to the laboratory for analysis and a report will be sent back to your doctor within a few days.

Both fine needle aspiration and core needle biopsy provide quick results and mean that you can discuss your treatment options with your doctor before you have surgery.

The procedure only takes a few minutes and can be done in your doctor’s rooms.  Results are usually sent back to your doctor within a couple of days.

Stereotactic core biopsy or Mammotome

This procedure is often used in women whose mammograms have identified a large number of calcifications in the breast. Calcifications can be an early indication of cancer, though most are nothing to worry about.

You will have a local anaesthetic and your breast will be compressed in the mammogram. A needle will then be inserted into the calcifications or area of concern and tissue samples will be taken.  These are then sent to the laboratory for analysis.

This procedure can take a few hours, but can still be done in your doctor’s office or radiologist’s rooms. 

Open Biopsy  

This procedure is performed in the operating theatre and you will need a general anaesthetic. The surgeon then uses a scalpel to cut away the area of suspected tissue for analysis. The cut is usually made near the nipple area to minimise scarring.

If the surgeon needs help in locating the area of concern, a “hookwire” or “wire localization” biopsy may be used.

This involves having a local anaesthetic in the breast before surgery. The surgeon then uses an ultrasound or mammogram to guide a small wire into the breast to pinpoint the exact area of concern. This helps the surgeon to find the area of concern once you are on the operating table for an open biopsy.

This procedure may take up to three or four hours and you should have someone available to drive you home. Your breasts are likely to be tender for a couple of weeks, but you should be able to resume normal activities, such as exercise, after this time.  

Other tests used to determine whether cancer has spread

CT Scan

   A CT or CAT scan stands for computerised tomography and is another kind of x-ray.  It takes a cross sectional image of the body and can be useful in showing whether the cancer has spread to other parts of the body, such as the lymph nodes, lungs, liver, brain or spine.

When you have a CT scan you lie on an examination table which then passes through a hollow cylinder. The procedure should only take a few minutes. 

Chest X-Ray

A chest x-ray is often done at the beginning of treatment for breast cancer to determine whether the cancer has spread to the lungs. It may also be used to asses the state of the heart and lungs before you begin intensive treatment which could put stress on these organs.

PET Scan

This stands for Positron Emission Tomography and is one of the newest imaging technologies available. Only some centres in New Zealand offer this service.

If you have a PET scan you are injected with a small amount of radioactive material before images are taken with a special camera. Cancer cells are more active than ordinary cells and so absorb more of this radioactive material.  These cells then show up on the images.

PET scans can be useful in detecting whether cancer cells have spread beyond the breast to the lymph nodes or other parts of the body or to determine whether you are responding well to treatment.

Fundraising Events

You can find out more about fundraising events for BCAC and our member groups.  We welcome your participation.  

Make a donation

More than 3,300 New Zealanders are diagnosed with breast cancer every year.

BCAC welcomes donations from individuals and companies to help us support and empower these women and men through their diagnosis, treatment and recovery.

If you would like to make a credit card donation to BCAC, please use the "Click here to donate button" to the right.  

Alternatively, payments can be made by direct debit (ASB, Ponsonby, 12-3019-0721100-00) or by sending a cheque to: P O Box 90224, Victoria Street West, Auckland 1142.

We greatly appreciate your involvement and support.

Sponsorship

On this page we are proud to list those trusts, individuals and companies who support our organisation.

We welcome your interest in becoming a sponsor of BCAC. Please join our team so we can work together to make a difference for all New Zealanders touched by breast cancer.

BCAC is willing to discuss with any company or individual the development of concepts and opportunities to both support our coalition and provide meaningful projects with which you can be aligned.

If you would like to know more about BCAC and how you can work with us, please email us.  

Our Supporters

  • Storage King NZ

  • Breast Cancer Foundation NZ

  • Le Reve

  • Karen Louisa Foundation

  • Ministry of Health and the National Screening Unit

  • The Good Registry

  • Ralph and Eve Seely Trust

  • Southern Trust

  • Oxford Sports Trust

  • Pub Charity Ltd

  • Trust House Foundation

  • Lottery Community

  • Dot Design.

Breast Cancer Organisations

Below we have listed some of the major organisations providing help, information and support for women with breast cancer in New Zealand.  

You may also want to check out our full list of member groups for more organisations committed to assisting women with breast cancer on a more local level.

Information:

Support

Health and Wellbeing

Research

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