Breast Cancer Surgery

If the area to be removed is small in relation to the size of the breast conserving surgery can be performed.

After breast conserving surgery you will usually be offered radiotherapy to the breast to prevent cancer coming back in the same breast. Studies have shown that breast conserving surgery followed by radiotherapy is as good as having a mastectomy in terms of long term survival.

My Oncoplastic training means I do my absolute best to ensure you have as good a cosmetic outcome from your operation as possible. I will discuss scar placement with you so you know what to expect afterwards.

Cancers detected on screening mammograms or detected on ultrasound scan are difficult to feel. You may have a wire placed under x ray control or under ultrasound guidance to guide the surgeon to remove the lump. This is called wire guided wide local excision.

A mastectomy is required if the cancer is large, and removing it would leave you with very little breast tissue. If there are more than one cancers in the breast, this may also lead to a mastectomy. A mastectomy will involve removing the nipple. If the cancer is large in relation to the size of the breast the cancer, or where there is more than one cancer within the breast then you may need complete removal of the breast including the nipple. This is called mastectomy.

The chest wall will be flat afterwards, with a long scar extending across it form just to the side of the sternum to the armpit. An external prosthesis can be used in the bra or you can consider delayed reconstruction after completion of treatments.

If you are having an immediate reconstruction, you may undergo a skin-sparing mastectomy. This means as much skin as possible is retained as a pocket for your reconstructed breast. This can be with or without the nipple. You will have a drain left in at the end of the procedure that will be removed after a few days.

In women with large or droopy breasts wide local excision (lumpectomy) can be performed as a part of breast reduction or breast lift. The operated breast will be smaller and more “pert” than the non-operated side. You will require surgery to the other breast (either at a later date or in the same operation) in order to match them. It is usually possible to preserve the nipple. You will have a drain left in at the end of the procedure and this will usually be removed the next day.

When you have your investigations to diagnose a breast lump, you will undergo an ultrasound scan of your axilla (armpit) to assess whether the lymph nodes look abnormal or not. If the nodes look abnormal or suspicious, you may need a biopsy to confirm spread to them. If this result is positive, you will need surgery to clear the nodes form the axilla.

If the lymph nodes look normal on ultrasound scan, you will undergo an smaller procedure on the armpit to diagnose a few nodes (sentinel nodes). The sentinel nodes are the most accurate group of nodes tested to determine of there has been any cancer spread.

In order to localize them, we use a dual technique.

1. A radioactive tracer injected beneath he nipple before surgery
2. A blue dye injected beneath the nipple once you are asleep for the operation

I will remove between 1 and 4 nodes that will be sent to the laboratory for analysis under the microscope. The results will be available along with your breast tissue analysis at your next clinic visit. If we find evidence of cancer spread to the lymph nodes, you are likely to need further surgery to clear the rest of the nodes in a separate operation.