Breast Cancer Surgery
Breast Cancer Surgery
The different types of breast surgery and what happens before, during and after:
Surgery is usually the first treatment that a breast cancer patient needs. Breast-conserving surgery (often called lumpectomy or wide local excision) is suitable for most patients but some women may need more extensive treatment with mastectomy depending on the extent of the disease. Most surgery can take place as a day case or overnight stay and results can usually be given a week later. The need for any further treatments (chemotherapy, radiotherapy, endocrine/hormone therapy) is based on the outcome of the surgery.
Mr Agrawal was caring thoughtful and very understanding. I cannot thank him enough. From the second I walked into his office at the Spire he put my mind at ease he explained everything I needed to know and didn’t leave anything out.
Preparing for breast surgery: What must patients do prior to surgery?
Generally, women can carry on without making any significant change prior to surgery. However, modifying lifestyle if smoking or drinking alcohol excessively can be beneficial. Stopping HRT or the contraceptive pill can also reduce risk. All patients will have a pre-operative assessment to ensure fitness for surgery and the breast care nurse will advise on anything required to optimise recovery.
Breast-conserving surgery:
A lumpectomy or wide local excision removes the breast cancer along with a margin of normal, healthy breast tissue. The aim is to retain as much breast tissue as possible while ensuring cancer has been completely removed.
It is important to ensure that there are clear margins around cancer before proceeding to further treatments.
Oncoplastic breast surgery is a specialised technique that can help to minimise deformity of the breast without compromising on cancer margin safety. This can involve remodelling the shape and volume of the breast and sometimes surgery to the unaffected breast for symmetry.
Radiotherapy is almost always given to women who have breast-conserving surgery, to reduce the chance of cancer recurring.
Mastectomy:
The extent of cancer may determine the need for mastectomy. Some women opt to have this even with smaller cancers. The survival outcome is thought to be comparable with either technique.
Some women at particularly high risk of developing breast cancer may be offered risk-reducing mastectomy surgery.
Reconstruction:
All women who undergo mastectomy can have a discussion around breast reconstruction. This can be carried out at the same time as the mastectomy with retention of much of the skin overlying the breast and sometimes the nipple can even be preserved, or at a later date. Options include using silicone implants or using donor tissue from other areas of the body (commonly the abdomen, thighs or back).
Lymph node surgery:
Breast cancer cells can sometimes spread to lymph nodes (glands) in the armpit. The breasts contain a network of tiny tubes called lymph vessels, that drain into the lymph nodes.
Lymph nodes are arranged in three levels. The total number of nodes in each level can vary from person to person. Anyone with invasive breast cancer will have the lymph nodes under the arm assessed.
If there is clinical evidence of disease in the lymph nodes before surgery, then it is usually recommended to have all or most of the lymph nodes removed. This is carried out at the same time as the breast surgery and is known as an axillary clearance.
Sentinel node biopsy is carried out in patients who have no evidence of lymph node involvement and again is done at the same time as the breast surgery. It identifies whether the sentinel lymph node (the first lymph node that the cancer cells are most likely to spread to) is clear of cancer cells. There may be more than one sentinel lymph node.
A small amount of radioactive material and a blue dye is injected into the breast to identify the sentinel lymph node. Testing of the sentinel node(s) during the surgery is sometimes also feasible, using One Step Nucleic Acid Amplification (OSNA).
The blue dye can cause discolouration of urine and other bodily fluids for one or two days after the procedure. The skin around the injection site may also be stained a blue-green colour. Some people may have an allergic reaction to the dye but this is rare and can be treated.
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