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BREAST CANCER SURGERY
Surgery is commonly the first line of treatment for breast cancer, and very often involves surgery to the breast and to the lymph nodesin the armpit of the affected side/s.
As part of treatment, surgery aims to remove the cancer from the breast. In the past, surgery to remove only the cancer growth left a high risk of cancer re-growing in the breast, therefore traditionally this meant mastectomy surgery, which involves removing all the breast tissue from the affected side. Advances in research have proven that radiation treatment to the affected side after surgery reduces this risk, therefore in many cases breast conserving surgery, usually followed by a course of radiotherapy, may be offered as treatment.
Where possible a choice of surgery is offered, or a recommendation may be made based on individual circumstances and your preference. In certain situations a mastectomy is the recommended surgery.
Does having more surgery improve chances of survival?
Some women think that having more extensive surgery to the breast may improve their chances of survival, however research has shown mastectomy surgery and breast conserving surgery are equal in survival outcomes (depending on an individual’s circumstances). Surgery options and long-term outcomes relate to the initial extent of disease, features of the cancer, clearance of cancer, and appropriate treatments undertaken.
TYPES OF SURGERY TO THE BREAST
BREAST CONSERVING SURGERY
Conserving surgery to the breast is also referred to as Wide Local Excision or Lumpectomy, and treatment usually involves:
- - Removal of the cancer with a rim of healthy breast tissue around it (margin), leaving the majority of the breast intact (usually also leaving the nipple & areola intact if possible)
- - Testing or removal of lymph nodes in armpit (axilla) of affected side [see section on Surgery to lymph nodes (axillary surgery)].
- - A course of radiation therapy (radiotherapy) to the breast after surgery
Breast conservation is usually offered where the tumour is small enough to be removed and leave an ‘acceptable’ cosmetic appearance of the breast. For larger tumours, chemotherapy may be given before surgery to shrink the tumour in attempt to achieve breast conservation – although this may still not always be possible.
What if the cancer cannot be felt?
Where the tumour cannot be felt in the breast, the surgeon needs a ‘guide’ to locate the cancer at surgery. This is often done by inserting a guide-wire (fine flexible wire also referred to as a ‘hookwire’), which is placed in the breast with aid of ultrasound or mammogram prior to surgery (either the day before or morning of), then coiled around and taped down. The wire is then removed with the surgery. Another method used is ‘carbon-marking’, which provides a carbon track to guide the surgeon.
New methods to locate the tumour are under trial, including the use of a radioactive ‘seed’ inserted prior to surgery to locate the tumour, which is then removed with surgery.
What to expect after breast conserving surgery?
- Breast conserving surgery will leave a scar on the breast at the incision site. The location of the scar will depend on the location of the cancer. Breast Surgeons aim to minimise the size and position of the scar for optimal cosmetic outcome, however the breast may be reduced in size & change shape – depending on the proportion of tissue needing to be removed.
- After surgery a dressing is placed over the wound, and is often removed after a day or two. Generally no dressing is required after this as wounds mostly heal well when not covered.
- In many cases a drain is not required after standard conserving surgery to the breast, however may be placed if required (check with your surgeon).
- Wounds are usually healing well after a week. Areas of sensitivity, altered sensation and numbness are common after surgery, especially around the scar. Stitches often do not need to be removed as many surgeons use dissolvable sutures. (NB: A stitch may be used to hold drain/s in place and will be removed when drains are taken out). Steri-strips (small adhesive strips applied to skin) may be used across the scar, and will often lift and peel off after a week or so. In most cases remaining steri-strips are removed at your post-surgery appointment.
- Testing or removal of the lymph nodes usually involves a separate incision under the armpit [see section on Surgery to Lymph Nodes (axillary surgery)]. A separate drain may be required after lymph node surgery.
MASTECTOMY
Mastectomy for breast cancer treatment refers to removal of all the breast tissue on affected side, usually including the nipple, areola and most of the overlying skin. The remaining skin edges are then closed to leave a flat scar across the chest.
Testing or removal of the lymph nodes in the armpit is usually done through the same incision [see section on Surgery to Lymph Nodes (axillary surgery)].
Mastectomy may be recommended if cancer is more extensive in the breast and breast conserving surgery is not possible. Mastectomy may also be an individual’s choice.
Why choose a mastectomy?
Some women may choose a mastectomy over breast conserving surgery to avoid a possible need for further surgery to the breast, or to avoid having radiotherapy treatment. (NB: Sometimes radiotherapy is recommended even after mastectomy where risk of cancer returning in the chest wall or armpit is high).
Sometimes women choose mastectomy as preventative (prophylactic) surgery where they carry a high risk of developing breast cancer – possibly from strong family history, carrying a gene-mutation, or evidence of high-risk disease. Prophylactic surgery is often combined with reconstruction, and may include retaining the skin, nipple & areola. NB: Lymph node surgery is seldom required if surgery is prophylactic.
What to expect after mastectomy?
- If no reconstruction is done at the time of mastectomy, the chest is usually flat on the affected side(s), and the scar often runs across the chest from beneath edge of armpit to middle of chest.
Following reconstruction, scars will vary depending on type of surgery and surgeon preference (see section on Reconstruction in FORUM).
- After surgery a dressing is placed over the wound, and is often removed after a day or two. Generally no dressing is required after this as wounds mostly heal well when not covered.
Usually 1-2 drains (plastic tube attached to a small bottle) are placed near armpit to drain fluid that collects at surgery site. These drains are usually removed after several days by a nurse or doctor.
- Wounds are usually healing well after a week. Areas of sensitivity, altered sensation and numbness are common after surgery, especially beneath the scar.
Stitches often do not need to be removed as many surgeons use dissolvable sutures. (NB: A stitch may be used to hold drain/s in place and will be removed when drains are taken out). Steri-strips (small adhesive strips applied to skin) may be used across the scar, and will often lift and peel off after a week or so. In most cases remaining steri-strips are removed at your post-surgery appointment.
What about prosthesis?
If no reconstruction at time of mastectomy (or have a reconstruction that requires expanding), then an external breast prosthesis may be worn to help provide symmetry or balance to breast shape in clothing. A temporary ‘soft-form’ prosthesis is usually provided by your breast care nurse or hospital staff. **If not received a ‘soft-form’, speak with your Breast Care Nurse or contact Cancer Council 131120 to arrange.
Once wounds are fully healed (~4-6 weeks in most cases), a permanent prosthesis may be fitted (see section on **Breast Prosthesis in FORUM {**NB To be posted soon!}).
** For information on Side-effects of breast surgery and Scar management, see separate posting in ‘Forum – Breast Cancer Surgery – Surgery to the Breast’.
Please add any comments or queries regarding breast surgery below …
The Click Breast Care Nurse 
