Traditionally, breast surgery for cancer included two operations – lumpectomy and mastectomy. These days, thanks to the techniques learned from cosmetic breast surgery, there is a much wider range of techniques available to enable the best treatment of your condition whilst maintaining the best cosmetic outcome possible. Occasionally, other non-surgical treatments may be the best for you. Coming to terms with a diagnosis of breast cancer is part of your personal journey that will inevitably leave physical and emotional scars. It is a really important part of Ms de Sousa’s care that she gives you the support that you need throughout your journey, from initial diagnosis, through treatment decisions and coming to terms with the long term.
This type of operation is performed to remove an area of tissue that is not thought to have worrying features. It does not need a wide margin of healthy tissue removed from around it and is often performed to help in diagnosis.
When an area of change within a breast has been found to contain cancer cells, it must all be removed together with a rim of healthy tissue around it. This is often done through an incision around the nipple or overlying the lump. It is only possible if the size of the change is small relative to the size of your breast.
Sometimes the area of cancerous change identified in a breast is extensive and will lead to a marked deformity when removed. The remaining tissue can be reshaped and remodelled using oncoplastic surgical techniques. These adapt the principles of breast reduction and uplift to cancer treatment, usually resulting in a smaller, lifted breast. The scars are more extensive than for a wide local excision and sometimes balancing surgery on the other side is needed. However, it allows removal of larger areas of tissue and women who in the past would have needed a mastectomy, are spared one.
If it is not possible to re-model a breast, for example in ladies with smaller breasts, then a small flap of tissue adjacent to the breast can be moved to fill a defect caused by wide local excision . This is sometimes known as LICAP or TDAP flaps and Ms de Sousa will discuss these with you if they are an appropriate option.
Mastectomy is removal of all the breast tissue. The decision to perform a mastectomy is taken after consideration of many factors. These are practical considerations such as the breast size, the cancer size and previous surgery or treatments. There may also be oncological recommendations based on the specific biology of a cancer or a family history. Most importantly, there may be patient preferences for or against having a mastectomy. All these are taken into account and discussed fully with you by Ms de Sousa before any decisions are arrived at.
Mastectomy has several forms. It is performed with or without immediate breast reconstruction.
A simple procedure involves removing the skin and tissue beneath, leaving the lady or gentleman with a flat chest wall and a straight scar.
Skin- Sparing mastectomy removes the tissue beneath the skin, but leaves the skin envelope with or without a nipple, beneath which to place a breast reconstruction. There are many ways that this procedure can be carried out, and Ms de Sousa will discuss those most appropriate to you once she has learned more about you and examined you.
Lymph nodes act as a filter for fluid draining from the breast. As part of most cancer treatments, the corresponding lymph nodes are examined for the presence or absence of disease. This is to assess the stage of cancer and to guide treatment recommendations. The armpit is usually scanned using ultrasound during your initial investigation. Then either of the two procedures below could be recommended.
Tracers injected into the breast tissue before an operation are used to guide your surgeon to the first lymph nodes in your armpit that receive fluid from the breast. These are assessed for cancer cells. Lymph node biopsy is also carried out when enlarged nodes are identified for other reasons.
If you are known to have cancer cells in your lymph nodes, you may be recommended to have removal of all accessible nodes, in order to reduce the risk of your disease causing further problems in the future.