Breast surgery operations
The type of surgery offered not only depends on the size of your breast cancer, but also the size of the lump in relation to your breast size. Not all breast cancers require the removal of all of the breast tissue (mastectomy) for effective treatment. Also, if a mastectomy is offered, this does not necessarily mean that you have a more aggressive breast cancer. For instance, for certain women with small breast volumes a wide local excision (lumpectomy), could be cosmetically unacceptable.
Wide local excision or lumpectomy
A wide local excision (WLE), which is also called a lumpectomy, is an operation that retains as much of the breast as possible. It involves the surgical removal of the cancerous area with a small border of normal tissue surrounding it, which we term the “clear margin”. Although this is most often the only operation required, 1 in 5 women will require further surgery to extend the “clear margin” because disease is found that could not be seen on pre-operation conventional imaging. Breast conserving surgery like WLE must be followed by radiotherapy to the breast to reduce the risk of local recurrence. A wide local excision and radiotherapy is as effective as a full mastectomy.
Breast removal or mastectomy and reconstruction
Mastectomy is the removal of all the breast tissue. Sometimes this includes removal of the nipple as well, but this is not always the case. At this unit, all women having mastectomy are offered immediate breast reconstruction, if this is appropriate. However, not everyone is suitable for reconstruction surgery.
If you are going to have a mastectomy and reconstruction is something you would like to consider, you will be assessed by an Oncoplastic (breast cancer and reconstructive) Surgeon and a Breast Surgeon to determine whether this is appropriate and what type of reconstruction would be best. The best option will depend it’s suitability to your body shape and current condition.
An experienced breast care nurse will be available throughout your journey to assist with some of these complex decisions.
In certain circumstances, the skin and occasionally the nipple can be preserved to optimise the final cosmetic appearance, however, this would never be done if it would affect your cancer treatment.
Sentinel node biopsy
If you have been diagnosed with breast cancer your axilla (armpit) will also have been examined with an ultrasound scan. This is to check to see if the disease has spread to the lymph nodes that are found there. Lymph is a liquid that bathes your breast cells and can move diseased cells to other parts of your body. If possible, any unusual looking lymph nodes will have sample taken using a needle and syringe. Even if the lymph nodes appear normal, we will still test them with a sentinel lymph node biopsy.
The sentinel lymph nodes are the most likely to show any disease as they are the first that the lymph reaches . Using a combination of low dose radioactive isotope and a blue dye, the sentinel nodes are located (usually 1 to 4 in number) during your breast surgery. The lymph node biopsies are sent to the laboratory to be analysed and the results are available within 2 weeks. If these lymph nodes are found to contain cancer cells then further management and treatment will be discussed with you.