Breast cancer surgery

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Your surgeon will discuss fully the type of breast cancer surgery they are recommending.  A nurse will be there to go through what has been said. Sometimes it is also helpful to have your partner or a friend with you.

Types of breast cancer surgery:

Lumpectomy (Wide Excision / Quadrantectomy / Segmentectomy)

This refers to a surgical removal of a lump with a surround margin of healthy tissue. All patients receive radiotherapy after surgery. The length of stay in hospital is usually 1-3 days. In some cases the surgeon has to re-operate because  analysis down the microscope shows the margins are incomplete which means that the excision edges are not cancer-free. The decision for a further resection depends on the type and grade of the tumour. Sometimes re-excision still fails so mastectomy is then recommended.

Mastectomy

Mastectomy refers to a breast cancer surgery  involving the removal of the entire breast but not underlying muscles. It  may be performed because local excise did not achieve complete margins or there was one of the following features at presentation. 

• Multifocal tumour.
• Large retro-areola tumour (behind the nipple).
• Large (> 5 cm) tumour in small breast.
• Radiotherapy contra-indicated e.g. previous radiotherapy to the chest area, increased radio sensitivity e.g. systemic sclerosis or rheumatoid arthritis.
• Patients preference - some patients still prefer the option of mastectomy.
• Pregnancy - particularly the early stages where it is not possible to give post operative radiotherapy.

Your length of stay in hospital can be anything from 3-10 days. Mastectomy reduces the need for radiotherapy (by about half).

Surgery to the armpit (Axilla):

It is important to know whether any malignant cells have spread from the original tumour into the local lymph nodes. The three surgical options include:-

• Axillary sample removal of 3-6 nodes. If positive further surgery or radiotherapy is required to the axilla.

• Axillary dissection - removal of the entire nodal tissue.

• Sentinel node biopsy - dye or radioactive material is injected into the skin around the tumour to make the dissection more accurate (1-3 node are usually removed).