Breast Cancer

Surgery

There are 2 main types of breast surgery for the treament of breast cancer. They are wide local excision (lumpectomy) and mastectomy (removal of the entire breast). The decision on what type of operation is dependent on many factors e.g. breast size, patient comorbidities, tumour size, tumour location, and other treatments after surgery such as radiotherapy.

 

Breast conserving surgery - Lumpectomy/wide local excision

Complete excision of the disease with a clear margin of normal tissue to ensure complete resection and preservation of the rest of the breast. If disease is not palpable, hookwire localization under mammographic or ultrasound guidance to target lesion will be required. Specimen assessment with specimen x-ray and will be marked and sent to histopathology for assessment. If margins are inadequate, further re-excision may be required in a separate setting.

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Mastectomy +/- reconstruction

A mastectomy is the removal of the whole breast. It is the most extensive form of breast surgery performed for breast cancer. It may also be performed as risk-reduction surgery for patients at high risk of breast cancer, such as those with genetic mutations.

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There are several reasons why a mastectomy may be recommended. Some of these reasons include:

• Large breast tumours

• Multiple breast tumours

• Aggressive breast tumours

• Breast conservation surgery which fails to achieve clear margins

• Patients unable to receive breast radiotherapy

• Risk-reduction surgery

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There are several different types of mastectomy. These include:           

• Total mastectomy: removal of the whole breast, including the nipple.

• Subcutaneous mastectomy: removal of the whole breast and nipple, leaving behind most or all of the skin of the breast. This is type of mastectomy is performed alongside a breast reconstruction.

• Nipple-sparing subcutaneous mastectomy: this is a type of subcutaneous mastectomy which leaves the nipple in place.

Not everyone is suitable for all types of mastectomy

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Breast reconstruction will be discussed when performing a mastectomy. The options for breast reconstruction are similarly individualised and often will require a couple of consultations to come to a decision. I perform implant-based reconstruction, which may not be suitable for all patients. If I think there is a better option, I will refer patients on to a plastic surgeon that specialises in breast reconstruction.

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Oncoplastic Surgery​

Oncoplastic breast surgery refers to performing breast cancer surgery with attention paid to achieving acceptable cosmetic results. Oncoplastic breast surgery has been shown to positively impact upon quality of life for breast cancer patients. A variety of surgical techniques are used to maintain breast aesthetics following the removal of a breast cancer

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​Complications from breast cancer surgery

Bleeding, infection, seroma (fluid collection), scar and wound healing issues are potential complications for all surgery. There is a 10-20% chance of more surgery required due to a positive margin. When removing the cancer, it is important to have some normal tissue around it (a margin) to be confident we have excised it all. If cancer extends to the margin, further surgery will be needed. This is only known a few days after surgery when the pathologist has examined the specimen. There may be more specific complications depending on your type of surgery that I will go into more detail at your consultation. It is important to ask questions and voice concerns such that you can comfortably make an informed decision.