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Invasive Ductal Carcinoma (IDC) Surgery in Los Angeles
Reviewed by Elizabeth Arena, MD, FACS.
IDC begins in a milk duct and grows into the surrounding breast tissue, but the right surgical approach depends on the cancer’s size, location, stage and biology, as well as your breast anatomy and priorities. Dr. Elizabeth Arena, a breast surgical oncologist in Los Angeles, considers each of these factors when determining whether an oncoplastic lumpectomy or mastectomy offers the best balance of effective cancer removal and breast preservation.
During surgery, Dr. Arena removes the cancer and, when appropriate, performs a sentinel lymph node biopsy to determine whether it has reached nearby lymph nodes. She works closely with medical and radiation oncologists so that surgery and any recommended radiation, chemotherapy, hormone therapy or targeted therapy form one coordinated treatment plan.
What is invasive ductal carcinoma?
A milk duct is one of the thin tubes that carry milk to the nipple. IDC is cancer that began in the cells lining a duct and has invaded the deeper breast tissue around it. [1] Older reports call it infiltrating ductal carcinoma and newer ones may call it invasive breast carcinoma of no special type (NST).
Outside the duct, IDC cells can enter the lymph vessels and travel to the lymph nodes under your arm. In most operations for IDC, Dr. Arena removes a few of those nodes for a pathologist to test.
What are the signs of IDC?
Many IDCs cause no symptoms and are found on a screening mammogram, as described in what happens after an abnormal mammogram. When there is a sign, it is usually one of these: [2]
- A lump: in your breast or under your arm.
- Skin changes: dimpling that looks like orange peel, redness, scaliness or thickening of the skin of your breast or nipple.
- Nipple changes: a nipple that turns inward, or discharge other than breast milk.
- Swelling or pain: swelling of all or part of your breast, or pain in your breast or nipple.
If you have found a change and have not had a biopsy yet, see what to do after finding a breast lump.
What does your pathology report mean for your operation?
Your biopsy report lists the type, size, grade and receptors of your cancer. [3] At your consultation Dr. Arena goes through each line with you and shows you the tumor on your own mammogram and ultrasound images.
| On your report | What it means | How it can affect your surgery |
|---|---|---|
| Invasive ductal carcinoma, or invasive carcinoma of no special type (NST) | Cancer cells have grown out of a milk duct into the breast tissue | An operation on your breast and in most cases on the lymph nodes under your arm |
| Tumor size | How large the cancer measures on your imaging and in the biopsy | A tumor smaller than 5 cm (2 inches) that is small for the size of your breast can usually be removed with a lumpectomy |
| Grade 1, 2 or 3 | How different the cells look from normal cells; grade 1 cancer grows slowly and grade 3 cancer grows fastest | Not one of the criteria for a lumpectomy; your medical oncologist uses it, with your other results, to decide whether you need chemotherapy |
| Estrogen or progesterone receptor-positive (ER+, PR+) | The cells use these hormones to grow | Hormone therapy after surgery, sometimes started before it |
| HER2-positive, or triple-negative (no ER, PR or HER2) | The cells make too much of a protein called HER2, or have none of the three receptors | Chemotherapy before surgery is preferred for many of these cancers, with HER2 drugs when the cancer is HER2-positive |
If your mammogram does not show how far the cancer extends, Dr. Arena may order a breast MRI before surgery, though your full stage, including whether cancer has reached your lymph nodes, is often known only after a pathologist examines the tissue she removes.
Is surgery the first treatment for IDC?
Surgery is the first treatment for most stage I and II IDC, meaning a smaller tumor that has reached no more than a few lymph nodes; for larger tumors and for many HER2-positive and triple-negative cancers, chemotherapy comes first and sometimes shrinks the tumor enough for a lumpectomy in place of a mastectomy. [4]
| Stage and receptors | Usual order of treatment |
|---|---|
| Stage I or II, hormone receptor-positive and HER2-negative | Surgery, then radiation, hormone therapy and sometimes chemotherapy |
| Stage II, HER2-positive or triple-negative | Chemotherapy, with HER2 drugs if HER2-positive, then surgery |
| Stage III: larger than 5 cm, growing into the skin or chest muscle, or in many lymph nodes | Chemotherapy, then surgery, most often a mastectomy |
Lumpectomy or mastectomy for IDC?
For IDC, as for any breast cancer, whether you can have a lumpectomy depends on the size of your tumor against the size of your breast, how many areas of cancer your imaging shows and whether you can have radiation. For early-stage cancer, survival is the same after either operation. A lumpectomy is usually possible when: [5]
- One area of cancer, or several close together: several areas in one part of your breast can be removed together if taking them out will not change the shape of your breast too much.
- A tumor smaller than 5 cm (2 inches): and small compared with the size of your breast.
- Radiation is possible for you: you are willing and able to go to the appointments and your breast has not had radiation before.
- No inflammatory breast cancer: a rare type that makes the breast red and swollen.
| Compared | Lumpectomy | Mastectomy |
|---|---|---|
| What Dr. Arena removes | The tumor and a rim of healthy tissue around it | All your breast tissue; in a nipple-sparing mastectomy, your skin and nipple stay |
| Radiation afterward | Usually needed | Usually only if cancer is found in your lymph nodes [4] |
| Hospital stay | Usually home the same day | Depends on the type of mastectomy and on reconstruction |
| Breast shape | Most of your breast tissue stays, reshaped with an oncoplastic lumpectomy when the tumor is large for your breast | Reconstruction is optional, at the same time or later, performed by a plastic surgeon |
If your age or family history suggests an inherited gene change such as BRCA1 or BRCA2, she offers genetic testing in the office, so the result comes back before you decide between a lumpectomy and a mastectomy. For the reasons women choose one operation over the other, see lumpectomy or mastectomy: how to decide.
What happens during surgery for IDC?
- Marking the tumor. If your tumor cannot be felt, a radiologist places a small marker in it using a mammogram or ultrasound. Dr. Arena uses the marker to find it during the operation.
- Removing the tumor. Dr. Arena removes the tumor with a rim of healthy tissue, placing the incision where it will be least visible, such as along the edge of the areola or in the fold beneath your breast.
- Checking the margins. A pathologist inks the outer surface of the tissue and looks at it under a microscope.
- For invasive cancer, the margin is clear when no cancer cells touch the ink. A wider rim of healthy tissue does not lower the chance of the cancer returning in your breast. Cancer cells at the ink double that chance, so Dr. Arena removes more tissue from that edge in a second operation (a re-excision) and recommends a mastectomy if cancer is still found after it. [6]
- Checking the lymph nodes, if you need it. A tracer injected before surgery flows to the sentinel lymph nodes, the first few nodes under your arm. In the same operation Dr. Arena removes them for a pathologist to check for cancer.
- Going home. After a lumpectomy you usually go home the same day and you can expect to be back to your regular activities within 2 weeks. [5]
Will you need lymph node surgery?
A sentinel lymph node biopsy is the lymph node operation used most often. If cancer is found in several lymph nodes, an axillary lymph node dissection removes a larger group. Two large clinical trials, SOUND and INSEMA, showed that lymph node surgery can be left out for some women with early-stage breast cancer, when all of these are true: [7]
- A small tumor: about 2 cm or less.
- Normal lymph nodes on imaging: your ultrasound shows no sign of cancer in the nodes under your arm.
- Hormone receptor-positive and HER2-negative cancer.
- A lumpectomy with radiation to the whole breast.
- Hormone therapy after surgery.
Lymphedema, long-lasting swelling of your arm or chest, follows about 5% to 17% of sentinel lymph node biopsies and 20% to 30% of axillary dissections. [7] Dr. Arena checks the nodes under your arm with ultrasound in her office and tells you whether you need a sentinel lymph node biopsy, a larger dissection or no lymph node surgery. See lymph node surgery for breast cancer.
Will you need radiation or other treatment after surgery?
Most women have radiation after a lumpectomy. After a mastectomy, radiation is usually given only when cancer is found in the lymph nodes. If your IDC is hormone receptor-positive, you also take tamoxifen (a pill that blocks estrogen) or an aromatase inhibitor (a pill that lowers estrogen after menopause) for at least 5 years. [4]
Dr. Arena sends your medical and radiation oncologists your pathology results, your imaging and her operative report, the record of what she removed. For how surgery, radiation and medicines fit together for every type of breast cancer, see breast cancer treatment.
Why choose Dr. Arena for IDC surgery in Los Angeles?
- Double board certification: Dr. Arena is double board-certified in general surgery and complex general surgical oncology.
- Fellow of the American College of Surgeons (FACS): the College grants Fellowship after reviewing a surgeon's training, surgical case log and ethical conduct. [8]
- In-office tests: breast ultrasound and genetic test samples, without a separate imaging or lab appointment.
- Same surgeon throughout: Dr. Arena reviews your biopsy report, performs your operation and sees you at your follow-up visits.
Dr. Elizabeth Arena uses advanced breast surgical techniques to keep as much of your breast as the size and position of your tumor permit. In an oncoplastic lumpectomy she fills the space where the tumor was with nearby breast tissue in the same operation, so your breast keeps its shape.
When the cancer is far enough from your nipple she performs a nipple-sparing mastectomy, leaving your skin and nipple in place for your plastic surgeon to rebuild the breast beneath them. If you meet the SOUND and INSEMA criteria, she does not operate on your lymph nodes at all, which removes the lymphedema risk that lymph node surgery carries.
Frequently asked questions
How serious is invasive ductal carcinoma?
In the United States, 64% of breast cancers are found while still confined to the breast. At that stage 5-year relative survival, compared with women of the same age without breast cancer, is 100%. It is 87.5% when cancer has reached nearby lymph nodes and 33.8% when it has spread to distant organs, figures that cover all types of breast cancer in US women and not any one woman's outlook. [9]
Is grade 2 invasive ductal carcinoma serious?
Grade 2 is the middle grade: the cells grow faster than grade 1 cells and more slowly than grade 3 cells. Your medical oncologist weighs it alongside your stage, hormone receptors and HER2 status. It does not change which operation Dr. Arena recommends.
How soon do you need surgery for IDC?
Dr. Arena schedules surgery once your imaging and any genetic test results are back and you have chosen your operation, or after your last chemotherapy treatment if your treatment starts with chemotherapy.
Should you get a second opinion for IDC?
Yes, if you are unsure about the operation you have been offered. Dr. Arena reviews your pathology report, your imaging and the other surgeon's recommendation. She tells you whether she would recommend the same surgery or a different one. See breast cancer second opinion.
Sources
- American Cancer Society. Types of Breast Cancer. Last revised August 26, 2026. https://www.cancer.org/cancer/types/breast-cancer/types-of-breast-cancer.html
- Breastcancer.org. Invasive Ductal Carcinoma (IDC). Updated December 5, 2024. https://www.breastcancer.org/types/invasive-ductal-carcinoma
- MyPathologyReport. Invasive Breast Carcinoma. July 1, 2026. https://www.mypathologyreport.ca/diagnosis-library/invasive-breast-carcinoma/
- American Cancer Society. Treatment of Breast Cancer Stages I-III. Last revised July 9, 2026. https://www.cancer.org/cancer/types/breast-cancer/treatment/treatment-of-breast-cancer-by-stage/treatment-of-breast-cancer-stages-i-iii.html
- American Cancer Society. Breast-conserving Surgery (Lumpectomy). Last revised July 1, 2026. https://www.cancer.org/cancer/types/breast-cancer/treatment/surgery-for-breast-cancer/breast-conserving-surgery-lumpectomy.html
- Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology-American Society for Radiation Oncology consensus guideline on margins for breast-conserving surgery with whole-breast irradiation in stages I and II invasive breast cancer. Journal of Clinical Oncology. 2014;32(14):1507-1515. https://pubmed.ncbi.nlm.nih.gov/24516019/
- American Cancer Society. Lymph Node Surgery for Breast Cancer. Last revised July 1, 2026. https://www.cancer.org/cancer/types/breast-cancer/treatment/surgery-for-breast-cancer/lymph-node-surgery-for-breast-cancer.html
- American College of Surgeons. Surgeon Qualifications and Certifications. https://www.facs.org/for-patients/preparing-for-surgery/qualifications/
- National Cancer Institute, SEER Program. Cancer Stat Facts: Female Breast Cancer (5-year relative survival by stage, SEER 21, 2016-2022). https://seer.cancer.gov/statfacts/html/breast.html
Speak with Dr Arena about your next step
Whether you have a new diagnosis, want another opinion, are weighing surgical options or need a concerning finding assessed, the first step is a consultation focused on your specific situation.
After you submit the request, the office will contact you to confirm the appropriate consultation and the records or information needed.
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