Breast Cancer Surgery

Surgery for a breast problem requires a high level of technical skill. It also requires a stong focus on aesthetic outcomes.

All of our surgical team are have oncoplastic training, which means we are able to offer you the full range of cosmetic procedures, following removal of a lump.

“In order to make sure you get the best treatment, our advice to you would be: ensure that your breast surgeon has oncoplastic training”

Breast Cancer Surgery – We offer the full range of oncoplastic breast surgery which includes breast conserving surgery, therapeutic mammoplasty, sentinel lymph node biopsy, mastectomy, breast reconstruction with implants and can readily access breast reconstruction with own tissue (autologous).
Non Breast Cancer Surgery – We offer the full range of breast surgery which includes breast reduction surgery, gynaecomastia surgery, breast lift surgery, revision of breast implants, removal of implants, fat transfer, augmentation and breast surgery for symmetry.

Breast cancer surgery involves removing the breast cancer from the breast tissue and remains an important treatment for breast cancer. The aim is to remove all the known disease with a margin of normal breast tissue around the cancer. This can be done as the first treatment for breast cancer (Primary surgery) or after the delivery of some treatment (for example chemotherapy first “Neoadjuvant Chemotherapy”).

It is important to review all the scans and undertake a full physical examination to understand which patients should be recommended a lumpectomy (wide local excision) or a mastectomy. Important considerations are patient choice / preference, family history / genetics, size of tumour and breast (breast to tumour ratio), previous radiotherapy, position and number of tumours as well as type of breast cancer (inflammatory breast cancer).

Almost 50-60 years ago, most women diagnosed with a breast cancer had a radical mastectomy which involved removal of the breast (mastectomy) and the lymph nodes (axillary clearance). A number of pivotal breast cancer trials in the 1980s and 1990s showed that in carefully selected patients the overall outcomes when comparing a mastectomy and lumpectomy with radiotherapy were similar.

Lumpectomy

A lumpectomy (wide local excision) may be recommended or preferred by the individual. It may be necessary to identify or “localise” the lesion (cancer) if it is not readily felt (palpable). This can be using a mark on the skin or a wire or a implantable device (seed or tracer). Surgery is undertaken under a general anaesthetic as a day case or overnight procedure. It may be possible to use ‘oncoplastic’ techniques to remodel the breast to minimise any deformity. Some women may be offered a ‘breast reduction’ technique to remove the cancer (therapeutic mammaplasty) or movement of tissue nearby (perforator flap) to reduce deformity.

Axillary Surgery

Surgery to the armpit (axilla) may also be recommended. The first place breast cancer cells (invasive breast cancer) travel to is the armpit lymph nodes (axillary lymph nodes). Assessment of this is performed by ultrasound (with or without a biopsy) or by surgery. Surgery may involve removing the first few draining lymph nodes (sentinel node biopsy using blue dye and radioactive material) or removing most of the lymph nodes (axillary clearance) if the lymph nodes already contain cancer. The main risks following surgery to the axilla area bleeding, damage to nerves causing pain and numbness and lymphoedema (swelling of the tissue).

Mastectomy and Reconstruction

Mastectomy involves removing most of the breast tissue. It is not realistic to be able to remove 100% of breast tissue as there will be some microscopic cells remaining. At the time of a mastectomy, an individual has the choice of a reconstruction. This involves an attempt to try to recreate a breast mound. There are 2 main questions to answer when considering breast reconstruction:

Should the reconstruction be done at the same time as the mastectomy (immediate reconstruction) or at a later time (delayed reconstruction) once all cancer therapy (radiotherapy in particular) is complete?
Should we use a breast implant device (fixed volume implant or tissue expander) or individual’s own tissue (autologous) to recreate the breast volume?

The decision about a mastectomy with or without a breast reconstruction is a very personal one. The breast surgeon’s role will be to discuss the various options, associated risks and benefits in the context of the whole breast cancer journey. Particular attention will be given to expected additional cancer therapy (radiotherapy, chemotherapy) and genetic testing (if appropriate). There are close ties to plastic surgical colleagues who offer autologous (own tissue) based reconstruction.

Following breast cancer surgery there will be a 1-2 week wait for the results which will assess: