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Breast Surgery

Breast Surgery

Lumpectomy

Breast problems are one of the most common health concerns among women and can affect them at any stage of life. The breasts undergo physiological (normal) or pathological (abnormal) changes with advancing age.

Lumpectomy, also called wide excision is a surgical procedure to remove a malignant tumour or a lump along with some of the surrounding normal tissue from a woman’s breast.

Lumpectomy is a type of breast conservation or preservation surgery.

Indications:

  • Early stage breast cancer
  • Non-cancerous breast abnormalities

Before the procedure:

Your doctor will perform a physical examination of the breasts. A mammogram is done to detect soft tissue abnormalities of the breast and a biopsy performed to obtain a tissue sample. Based on the findings of the mammogram and biopsy, you may be advised to undergo a lumpectomy.

Procedure:

The aim of the procedure is to remove the abnormal tissue and retain the normal appearance of the breast.

Lumpectomy is usually performed as an outpatient procedure either under local or general anaesthesia.

  • An incision is made over the tumour or the area that has been marked as abnormal by a radiologist. The surgeon then removes the tumour along with a small layer of surrounding tissue and sends it to lab for investigation. Your surgeon may also remove lymph nodes in your armpit (axilla) to see if cancer has spread to the lymph nodes.

At the end of the procedure, the incisions are closed with sutures and a soft dressing is placed over the surgical area.

After the procedure:

  • Make sure you get enough rest so that you can return to normal activities in a few days.
  • Your doctor will prescribe medications and antibiotics to reduce pain and inflammation.
  • Keep the incision are clean and dry to avoid infection.
  • A follow-up appointment should be scheduled 1-2 weeks after surgery to examine your progress.

Lumpectomy is usually followed by radiation therapy to stop cancer growth, spread, or recurrence.

Complications of lumpectomy include bleeding, infection, pain, swelling, scar tissue formation, a change in the size and shape of the breast.

Mastectomy

Mastectomy is a surgery to remove the breast, usually performed to treat or prevent breast cancer. There are 4 main types of mastectomy depending on the stage of cancer, size of the breast tumour and lymph node involvement:

  1. Total mastectomy: In this procedure, all of the breast tissue, including nipple are removed.
  2. Modified radical mastectomy: It involves surgical removal of entire breast, lymph nodes under the arm, and the lining over the chest muscles.
  3. Radical mastectomy: It is a surgical removal of the entire breast tissue, all the lymph nodes in the arm pit and chest muscles that lie under the affected breast. It is a rare procedure and is now only performed on patients who have advanced breast cancer.
  4. Nipple and Skin Sparing Mastectomy: This technique can be used in combination with the above surgeries to retain your natural skin and nipple. This can only be done when the tumour is at least 2 comes away from the tissue that is to be retained.

Indication

Mastectomy is recommended when your breast is affected with cancer or you have a high risk of developing breast cancer. Total mastectomy is usually indicated for patients with non-invasive breast cancer, Paget’s disease of the breast, or recurrent breast cancer.

Modified radical mastectomy is usually indicated for patients with early-stage breast cancer, locally advanced breast cancer (to shrink the tumour after chemotherapy), inflammatory breast cancer (mostly after chemotherapy), or Paget’s disease of the breast.

Procedure

Prior to your surgery, your nurse or surgeon will mark the area where the cut will be made. The procedure is performed under general anaesthesia. The surgeon will make an oval shaped incision around the nipple, across the breadth of the breast. Depending on the type of mastectomy, the breast tissue underlying the skin will be removed, along with lymph nodes and the inner layer of muscle tissue. The surgeon will then insert surgical drains, (tubes to collect excess fluid) and close the incision.

Reconstruction

If you choose to rebuild your breasts after mastectomy, your plastic surgeon will perform a surgery called breast reconstruction. During reconstruction, your surgeon creates a breast mound using an implant or tissue flap taken from your stomach, thighs, back, or buttocks. The reconstructive surgery can be done during or after mastectomy.

Post-op care

This surgery will require you to stay in the hospital for about 3 days or a little longer if you have opted for immediate reconstruction. After discharge, you will be given instructions on how to care for the surgical drain, bandage and stitches. In order to avoid stiffness and scar formation, you will have to follow some simple hand exercise regimes. Your surgeon will also recommend the appropriate time for you to start wearing a bra or prosthesis.

If you do not develop any complications from the surgery, you can resume physical activities within 6 to 8 weeks.

You may experience sensation or pain in the breast that has been removed (phantom pain) over a period of months after surgery. Pain medications can be used to treat this type of pain.

Risks and complications

Mastectomy procedures are usually safe, but may involve the risk of infection, bleeding, pain, swelling in your arm, hard scar tissue formation at the site of surgery, shoulder pain and stiffness, numbness (especially under your arm), and accumulation of blood in the surgical site.

Breast Biopsy

Breast biopsy is a procedure in which a small sample of breast tissue containing suspicious breast growth is removed and examined in the laboratory for the presence of cancer. It is indicated when abnormal findings are seen during mammography, ultrasound or MRI scans, or unusual changes are noticed in the nipple (dimpling skin, scaling or bloody discharge) or breast tissue (thickening or lumps).

The area of interest may be numbed to keep you comfortable. The procedure for conducting a breast biopsy depends on factors such as the size and location of the breast defect. The types of breast biopsy procedures include:

  • Fine-needle aspiration biopsy: Your doctor inserts a thin needle into the lump detected during a breast exam to draw a sample of fluid or cells.
  • Core needle biopsy: Your doctor inserts a needle guided by ultrasound or MRI to remove a sample of breast lump detected during a breast exam, ultrasound or mammogram. Several, grain-sized samples of the tissue are removed.
  • Stereotactic biopsy: A mammogram is used to identify the location of the suspicious areas within the breast. Your doctor makes a small incision and removes several samples of tissue through a needle or vacuum-powered probe.
  • Ultrasound-guided core needle biopsy: This type of biopsy is done under the guidance of ultrasound. Your doctor locates the mass by holding the ultrasound device against your breast. A small incision is made and a needle is inserted to remove several samples of tissue.
  • MRI-guided core needle biopsy: Your doctor makes a small incision into your breast under the guidance of MRI to insert a core needle for collecting samples of tissue.
  • Surgical biopsy: Your doctor surgically removes a part or entire breast lump under intravenous or local anesthesia.

The collected tissue is then forwarded to the pathologist for microscopic analysis. The pathology report will tell if you have breast cancer or not, if the lump is benign or cancerous and the type of breast cancer. Based on the results, your doctor will discuss a suitable treatment plan to treat and manage the breast cancer.

Other Procedures

  • The University Of Sydney
  • Royal Australasian College Of Surgeons
  • Royal College Of Physicians Surgeons Of Glasgow
  • AMA Queensland
  • General Surgeons Australia
  • International Society of Surgery
  • St Vincents Health Australia
  • Ramsay Health Care
  • American Board of Independent Medical Examiners