Breast Clinic

Breast cancer surgery is full of options. It is our job at The Womens Clinic to arm you with knowledge, give you advice and support you in your decision making process and beyond. We want to make it as easy as it can be for you.

Breast cancer surgery without reconstruction

Partial Mastectomy

What is it?

This surgery involves removing the cancer with a rim of normal breast tissue around it. The majority of the breast tissue is left so the breast has a scar but otherwise looks relatively normal. Not all breast cancers can be treated with a partial mastectomy.

Is Radiotherapy Required?

Yes, radiotherapy is required on the remaining breast tissue on the cancer side. This decreases the risk of the cancer returning in that breast.

Mastectomy

With a mastectomy, all of the breast tissue is removed, including the nipple & areola. If no reconstruction is performed, there is a scar across the chest and it appears flat on the affected side.

Usually no, however some women may be offered radiotherapy to the chest wall if they are at specific risk of the cancer returning

Is Underarm (Axillary) Lymph Node Surgery Required?

Yes, either Sentinel Lymph Node biopsy or Complete Axillary Lymph Node removal.

Why is Underarm lymph node surgery required?

In most cases, the first place a breast cancer spreads is to the lymph nodes under the arm. We perform axillary surgery to see if any of the underarm lymph nodes have cancer cells within them. This allows us to be more certain as to whether the cancer has spread or whether it is only within the breast tissue. We perform either a sentinel lymph node biopsy or complete axillary lymph node removal on all women who have been diagnosed with breast cancer.

What is a Sentinel Lymph Node Biopsy?

Guiding techniques allow us to identify the first lymph node in the underarm chain of lymph nodes that receives drainage of fluid & cells from the breast. This is the lymph node at greatest risk of containing cancer cells if the cancer has spread from the breast. We remove this Sentinel Node & look at it closely under the microscope to see if it contains any cancer cells. If it does, we remove the rest of the underarm lymph nodes. If no cancer cells are present then we do no further axillary node surgery. It is performed at the same time as your breast cancer surgery.

What is Complete Removal of Axillary Lymph Nodes?

This is underarm surgery that involves removal of all of the lymph nodes under the arm. This allows us to remove any cancer cells that may have spread from the breast. It is performed at the same time as your breast cancer surgery.

Will the Cancer come back?

Partial Mastectomy is a safe cancer operation when performed correctly. The chances of surviving long-term when compared with having a Mastectomy are the same. However, there is slightly increased risk of the cancer returning in the remaining breast tissue when compared with removing all of the breast tissue on that side (ie. Mastectomy). If you choose to have a Partial Mastectomy then you must complete the course of radiotherapy following surgery so that the chance of the cancer returning is minimized.

How many nights in Hospital
following Surgery?

1 night
After having a Mastectomy, the chances of the breast cancer returning on the chest wall are very small. Long-term survival is the same for Mastectomy or Partial Mastectomy.








2 nights

How long off work?

Usually 2 weeks. This can vary depending on how physical your job is and how fast you recover from your operation. Your arm movements may be affected on the surgery side but usually return to normal quickly with self-directed physiotherapy.

What Follow-Up is required?

We will follow you closely over the subsequent 2-5 years. This will include clinical examination every 6-12 months and yearly mammograms (on the unaffected breast in the case of Mastectomy) for 10 years.

Will I need Chemotherapy, Herceptin or Hormone Treatments?

These treatments are offered to you by the Medical Oncologist, who is responsible for administering them. Some women do not need any of the treatments and some may need all of them. This will depend on a number of factors including cancer factors, personal factors & personal choice. We will discuss with you the potential benefit that each treatment can give you & also the risks and side effects that you could expect.

Breast cancer surgery with reconstruction

Breast Reduction

(following Partial Mastectomy)

What is it?

Following a Partial Mastectomy to remove the breast cancer, a Breast Reduction is performed. This reduction is replicated on the unaffected breast to create symmetry. This has the effect of decreasing the size of the breast and also lifting the nipple and areola to eliminate breast droop.

Who is suitable for this surgery?

Women who want to have smaller breasts than they currently have are best suited to this type of surgery. The cancer must involve ‹30% of the total size of your breast.

Will I require surgery on the other breast?

Yes the other breast will be reduced, usually at the same operation so that the 2 breasts remain symmetrical

Will I need an Implant?

No

Will I need Radiotherapy?

Yes, to prevent the cancer from coming back in the breast tissue that remains on the cancer affected site.

How long does the operation take?

About 2-3 hours

How long will I be in Hospital?

2 nights

How long will I be off work?

1-2 weeks

What are the potential complications of the surgery?

Bleeding, infection, further surgery if not enough breast tissue around the cancer has been taken, nipple/areola failure, fat necrosis causing breast lumpiness, unsatisfactory cosmetic outcome.

Reconstruction with Implants

(following Mastectomy)

All of the breast tissue (including the nipple and areola) is removed but the skin envelope of your breast is left intact. A pocket is made under the muscles that cover your chest and an expander (inflatable breast-shaped balloon) is inserted. This is able to be inflated to the desired breast size via a port that sits under your skin. Once you are happy with the size of your new breast, a second operation may be required to insert the permanent implant and to achieve any finishing touches. A nipple can be reconstructed at this operation as well.
Women with C-cup sized breasts or smaller are best suited to this type of surgery. Additionally, women with a larger breast size that would prefer to be smaller on both sides (ie C-cup or smaller) are also suitable.
Sometimes a breast lift (mastopexy) may be required to eliminate breast droop on the non-cancer side and create breast symmetry.
Yes
Not usually
About 2-3 hours
2 nights
1-2 weeks
Bleeding, infection, slippage or
mal-positioning of implant.
Unsatisfactory "out-of-bra" cosmetic
outcome. Further surgery to improve
cosmesis/breast symmetry

Reconstruction Using Your Own Tissue

(following Mastectomy)
 

BACK MUSCLE (Lat-Dorsi Reconstruction)
ABDOMINAL TISSUE (TRAM/DIEP)
All of the breast tissue (including the nipple and areola) is removed but the skin envelope of your breast is left intact. The Latissimus Dorsi (back muscle) is lifted along with some skin and fat and tunnelled under your arm and onto your chest in order to create a new breast. An implant may or may not be required to create a new breast of the desired size. A new nipple can be reconstructed at a later operation. All of the breast tissue (including the nipple and areola) is removed but the skin envelope of your breast is left intact. A long cut is made across your lower abdomen and skin and subcutanous fat with or without muscle is taken up into the breast area and used to make a new breast shape. Sometimes microscopic surgery is required so that the new breast has an adequate blood supply. A nipple can be reconstructed at a later operation.
Women with breast cancer requiring mastectomy who are generally in good health (non-smoking). Those with no previous Abdominal surgery if considering abdominal tissue reconstruction. Those with no existing Back problems if considering back tissue reconstruction
No, it is not likely you will require surgery to the other breast
Usually Sometimes
Not usually Not usually
About 4 hours About 6-10 hours
3-4 nights 6-8 nights
3-4 weeks 6-8 weeks
Bleeding, infection, back wound complications (bleeding, infection, seroma), inadequate blood supply to reconstructed breast causing skin/muscle loss, "twitching" muscle syndrome, unsatisfactory cosmesis, back muscle weakness.; Bleeding, infection, abdominal wound complications (bleeding, infection, seroma, hernia or abdo wall bulging), weakness, inadequate blood supply to reconstructed breast casuing skin/muscle loss.

Will having a reconstruction adversely affect the cancer outcome?

No. Our main priority is to remove the cancer entirely. This is the same if you have a reconstruction or not. You still may be advised to have chemotherapy, radiotherapy, herceptin or hormone treatment even after having a reconstruction. Women who choose to have a reconstruction are not at increased risk of cancer recurrence and we will be able to identify a recurrence in the same way as we do for women who have not had a recontruction (i.e. clinical examination, imaging -Mammograms, USS and MRI) and needle test for looking at cells.