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Breast Surgery

Sentinel Lymph Node Biopsy and Axillary Dissection

A sentinel lymph node biopsy is a surgical technique that assesses whether breast cancer has spread to lymph nodes in your armpit, called the axilla. The advantage of a sentinel lymph node biopsy is that it identifies the node most likely to contain cancerous cells. If none are found, then no additional nodes need to be removed.

If cancer cells have spread to the lymph nodes in the axilla, you might need an operation called an axillary lymph node dissection to remove them.

Breast-Conserving Surgery: Lumpectomy

During a lumpectomy (or partial mastectomy), our surgeon removes the tumor and some surrounding tissue, rather than the entire breast. It is the preferred choice when only one tumor is present. Following a lumpectomy, many women will need radiation therapy to ensure there are no remaining cancer cells. If chemotherapy is also needed, it generally starts before radiation.

  • Oncoplastic Techniques: During lumpectomy, we carefully remove tumors with attention to achieving the best appearance possible. Although oncoplastic surgery is more complex, our surgeons are expert in restoring symmetry and appearance — preserving the breast’s form while matching its size as close as possible to the other side. While our breast surgeons and plastic surgeons often work together during these surgeries, some of our breast surgeons now have additional training in this specialized field and operate alone. 

Mastectomies That Spare Nipple and Skin

If you have a larger tumor or several tumors throughout your breast, you may need a mastectomy to remove the entire breast and, in some cases, nearby tissue and lymph nodes. You may also need a mastectomy if cancer returns after a lumpectomy and radiation. We strive not only to remove the cancer completely, but also to do so in a way to minimize the physical, emotional and psychological impact.

Our approaches include:

  • Scar Avoidance: We use small incisions when possible to remove breast tissue.
  • Skin-Sparing Techniques: In many cases, we can leave the nipple and the areola complex intact, to maintain your previous appearance as much as possible. With the skin-sparing method, the nipple, areola and breast tissue underneath the skin is removed — an approach that has been shown not to increase the risk of cancer returning.
  • Nipple-Sparing Techniques: In select patients, the breast tissue is removed through an incision without removing the nipple-areolar complex or any skin. You should have a discussion with your surgeon and plastic surgeon to see if you are a candidate for this procedure.

Immediate Breast Reconstruction

After a mastectomy, most women are candidates for breast reconstruction, and many choose to do so. Our well-trained plastic surgeons are able to restore a natural look through a number of approaches, many of which they pioneered or refined:

  • Autologous Tissue Flaps: Tissue is carefully taken from elsewhere in your body, usually from the back, stomach, thighs and/or buttocks.
  • Implants: We mainly use a silicone-based gel, which won’t leak even in the rare event of rupture. We often start with a tissue extender, a balloon-like device that helps mold the right size and shape before the implant is placed.

The collaboration between our breast and plastic surgeons allows us to offer immediate reconstruction after breast surgery, when appropriate. Many patients appreciate this approach, which offers the benefit of having two procedures during a single operation and single dose of anesthesia.

Prophylactic Mastectomy

If you have a significant family history of breast cancer, or carry the BRCA1 or BRCA2 gene mutations, you may consider having an elective mastectomy, known as a prophylactic, preventive or risk-reducing procedure. This surgery removes your breast(s) to decrease the chance you will develop cancer. While many women appreciate the opportunity to participate personally in reducing their risk, a prophylactic mastectomy does not guarantee you will avoid breast cancer. Other potential consequences to consider include:

  • The breast surgery is irreversible.
  • You cannot breastfeed from a reconstructed breast.
  • Reconstructed breasts lose feeling and sensitivity.
  • Some women experience changes in the way they feel about their body image.

Our surgeons help you determine whether this approach is best suited for your situation and needs. If you decide to pursue this option after careful consideration, we offer you the best care available, in an atmosphere designed to put you at ease. 

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MedStar Georgetown University Hospital
3800 Reservoir Rd., NW
Washington, D.C. 20007

MedStar Montgomery Medical Center
18101 Prince Philip Dr.
Olney, MD 20832

MedStar Washington Hospital Center
110 Irving St.
Washington, D.C. 20010

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