Breast Surgery Program

About This Program

The Breast Surgery Program in the Division of Gastrointestinal & Oncologic Surgery 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 Gastrointestinal & Oncologic Surgery 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 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.

Mass General Difference

Mass General is consistently recognized 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 over a dozen different 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.

What to Expect for Your 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 Gastrointestinal & Oncologic Surgery, 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

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:

• Be eligible for clinical trials, which study the effects of breast cancer treatment, while at our center
• Be screened for breast cancer-related lymphedema in our Lymphedema Program
• Undergo physical therapy after surgical treatment of breast cancer
• Participate in supportive and integrative care and survivorship programs

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 our division 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 Gastrointestinal & Oncologic Surgery, 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 our division have been leaders in developing surgical techniques for nipple-sparing mastectomy and research associated with the safety of nipple-sparing mastectomy.

Learn more about nipple-sparing mastectomy

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 cancer research »

In the News

How Boston Doctors Are Working to Get Breast Cancer Screening Results to Women Faster—NBC Boston 07/29/2021

A new program at Mass General is dedicated to getting more women screened for breast cancer and sharing their test results with them faster.

‘This is a Godsend’: Doctors, Spurred by the Pandemic, Try to Make Breast Cancer Screening Easier and Faster—The Boston Globe 07/10/2021

During the COVID-19 pandemic, rates of cancer screenings dropped dramatically. But since mammography centers reopened in the summer, the rising rates still haven’t made up for all the missed exams and, furthermore, have revealed long-standing racial and ethnic inequities. Spurred by these findings and the pandemic, Mass General doctors and others work to make breast cancer screening easier and more equitable through an immediate-read program that offers results to patients right away, equally.