Breast Cancer Surgery

What is Breast Cancer Surgery?

Breast cancer surgery is a key component of breast cancer treatment, involving the removal of cancerous tissue from the breast. The primary goal of this surgery is to remove the tumour and ensure that the cancer has not spread to other parts of the body. 


Who is Suitable for Breast Cancer Surgery?

The suitability for breast cancer surgery depends on several factors, including:

  • Stage and grade of the cancer: Early-stage cancers are often treatable with surgery. Surgery may still be an option in more advanced stages, but often in conjunction with other treatments.
  • Type of breast cancer: Some aggressive types of breast cancer might require more extensive surgery.
  • Size of the tumour relative to the breast: Smaller tumours might be eligible for lumpectomy, while larger ones might necessitate a mastectomy.
  • Patient’s overall health and preferences: Patient health, including other existing medical conditions and personal preferences about treatment options and potential outcomes.


Benefits of Breast Cancer Surgery

The primary benefits of breast cancer surgery are aimed at controlling the spread of cancer and improving survival rates. Specific benefits include:

  • Removing the cancer: Surgery is the most direct way to remove a tumour and can be curative if the cancer has not spread.
  • Determining the extent of cancer spread: During surgery, lymph nodes are often examined, which helps in staging the cancer accurately and planning further treatment.
  • Reducing the risk of recurrence: Removing the tumour and surrounding tissue reduces the risk of cancer returning in the breast.
  • Paving the way for reconstruction: For those undergoing mastectomy, modern surgical techniques often allow for immediate or delayed breast reconstruction, offering psychological and cosmetic benefits.


Breast Cancer Patient Journey

The patient journey for someone diagnosed with breast cancer involves multiple stages, from the initial discovery of symptoms to post-treatment care. Each step in this journey is crucial and involves various healthcare professionals to ensure comprehensive and effective treatment.


Symptom Recognition and Initial Consultation

The journey often begins when a patient notices symptoms, such as a lump in the breast, changes in breast shape or texture, skin dimpling, or unusual nipple discharge. Recognizing these signs prompts a visit to a general practitioner or, if the symptoms are more pronounced, directly to a specialist.


Clinical Examination and Referral

During the initial consultation, the doctor conducts a thorough clinical breast examination. Based on this assessment, if breast cancer is suspected, the patient is referred to a specialist—usually a breast surgeon or an oncologist.


Diagnostic Imaging and Biopsy

The next step involves diagnostic imaging tests such as mammography, ultrasound, and MRI to get a detailed view of the breast tissue. If these imaging studies suggest the presence of cancer, a biopsy is performed where a sample of breast tissue is taken to confirm the presence of cancer cells.


Diagnosis and Staging

If the biopsy confirms breast cancer, additional tests may be performed to determine the stage of the cancer. Staging involves assessing the size of the tumour and checking if the cancer has spread to lymph nodes or other parts of the body. This stage is critical for planning the appropriate treatment strategy.


Treatment Planning

The patient meets with a multidisciplinary team (MDT) that typically includes a breast surgeon, medical oncologist, radiation oncologist, pathologist, and a nurse or patient navigator. This team will review the diagnostic and staging information to develop a personalised treatment plan that may include surgery, chemotherapy, radiation therapy, hormonal therapy, or a combination.


Treatment Implementation

Treatment generally begins with surgery to remove the tumour and additional therapies if needed. The type and extent of surgery depend on the tumour’s characteristics and patient preferences. Post-surgery treatments like chemotherapy or radiation may be employed to eliminate any remaining cancer cells and reduce the risk of recurrence.


Follow-up and Monitoring

After treatment, regular follow-ups are crucial. These visits allow the healthcare team to monitor the patient's recovery, manage any side effects of treatment, and detect any signs of cancer recurrence. Monitoring typically includes physical exams, mammograms, and other relevant tests.


Rehabilitation and Support

Rehabilitation services and support groups are vital for helping patients cope with the physical and emotional impacts of breast cancer and its treatment. Rehabilitation might involve physical therapy, counselling, and support with nutritional and lifestyle changes.


Long-term Care and Surveillance

Long-term care involves ongoing monitoring to manage late side effects of treatment and surveillance for secondary cancers or recurrence. Patients may continue to have periodic visits with their oncology team, supplemented by support from community resources and survivorship programs.


Types of Breast Cancer Surgery

The various surgical options for treating breast cancer can be broadly categorised into surgeries aimed at conserving the breast, complete breast removal, and axillary surgeries for assessing the spread to lymph nodes.


Breast-Conserving Surgery

Lumpectomy / Wide Local Excision

This is a form of breast-conserving surgery where the tumour and a margin of surrounding healthy tissue are removed. It’s often suitable for early-stage tumours that are confined to one area of the breast.


Hookwire Guided Lumpectomy

This technique is used when the tumour is not easily palpable or visible on imaging. A wire is placed into the breast before surgery to guide the surgeon directly to the location of the cancer, ensuring precise removal of the tumour along with adequate surrounding tissue.


Oncoplastic Breast Surgery

This approach combines cancer surgery and plastic surgery techniques to effectively remove the tumour while also considering the breast's cosmetic outcome. Techniques such as reduction mammaplasty (reducing the breast size) and internal flaps (rearranging the remaining tissue to fill the defect left by the tumour removal) are used.


Mastectomy

Simple Mastectomy

This procedure involves removing the entire breast, including the tissue, skin, areola, and nipple. It is typically recommended when a larger area of the breast is affected.


Skin-Sparing Mastectomy

This procedure involves removing all the breast tissue while preserving most of the breast skin, which is beneficial for immediate reconstruction. It’s suitable for patients who plan to undergo breast reconstruction immediately after mastectomy.


Nipple-Sparing Mastectomy

Similar to the skin-sparing mastectomy, this surgery goes a step further by preserving the nipple and areola. It's particularly considered when the cancer is located away from the nipple and the patient desires a more natural look after reconstruction.


Breast Reconstruction

This surgery can be performed at the time of the mastectomy (immediate reconstruction) or at a later time (delayed reconstruction). Techniques include using implants or autologous tissue (tissue from another part of the patient’s body) to reconstruct the breast.


Axillary Surgery

Sentinel Node Biopsy

The first few lymph nodes (sentinel nodes) to which cancer is likely to spread are removed and analysed. If no cancer is found, further lymph node removal may not be necessary.


Targeted Axillary Dissection

This is a newer technique that targets specific lymph nodes that have been identified as containing cancer, typically those previously marked with a clip during biopsy, and spares others, reducing the risk of side effects.


Axillary Lymph Node Dissection

This involves removing many lymph nodes in the armpit area. It is usually performed if cancer has been found in the sentinel nodes, indicating a higher likelihood of further lymphatic spread.


Preparation Before Breast Cancer Surgery

  • Preoperative Assessments: Medical evaluation, including blood tests, imaging studies, and consultations to assess your overall health and plan the surgery. Meetings with your surgical oncologist and possibly a plastic surgeon if reconstruction is planned.
  • Medication Review: Discuss all medications you are taking with your doctor; some may need to be stopped before surgery, especially blood thinners.
  • Fasting: You'll likely be instructed to fast (not eat or drink) for a certain period before the surgery, usually after midnight the night before.
  • Preparation at Home: Arrange for someone to drive you to and from the hospital and help around the house during your recovery.
  • Mental Preparation: Consider meeting with a counsellor or joining a support group to address any fears or anxieties about the surgery.


Breast Cancer Surgery Procedure

The specifics of the procedure depend on the type of surgery being performed:

  • Anaesthesia: General anaesthesia is typically administered so you will be asleep during the surgery.
  • The Surgery: For lumpectomies and mastectomies, the surgeon removes the tumour and possibly some lymph nodes. The extent of tissue removal varies based on the surgery type. In oncoplastic surgeries and reconstructions, additional procedures to reshape or reconstruct the breast are performed.
  • Duration: The length of the surgery can vary from one to several hours depending on the complexity and whether reconstruction is done simultaneously.
  • Hospital Stay: Some surgeries, like lumpectomies, may be outpatient, meaning you can go home the same day. Others, particularly those involving reconstruction, may require a hospital stay.


Breast Cancer Surgery Recovery Plan

  • Physical Activity: Gentle exercises, like walking, are encouraged soon after surgery to reduce complications. Specific exercises may be recommended to prevent stiffness and improve the range of motion.
  • Diet: Eating a balanced diet rich in vitamins and proteins can help speed up recovery.
  • Emotional Support: Emotional and psychological challenges are common. Support from friends, family, or professional therapists can be crucial.
  • Rehabilitation: Engage in rehabilitation programs if recommended, including physical therapy or consultations with a dietitian or counsellor.
  • Regular Monitoring: Adhere to all scheduled follow-ups to monitor for signs of recurrence and manage any side effects or complications from the surgery.


Breast Cancer Surgery Prognosis

Early detection and treatment can lead to a better prognosis. Surgical outcomes are also influenced by the cancer’s hormone receptor status and genetic markers like HER2/neu. Patients with small and confined tumours generally have a higher likelihood of successful treatment and long-term survival. Regular follow-up is essential to monitor for any signs of recurrence.


Breast Cancer Surgery Risks

As with any surgical procedure, breast cancer surgery carries potential risks and complications. These include:

  • Infection and Bleeding
  • Lymphedema
  • Changes in Breast Sensation
  • Pain and Discomfort
  • Scarring and Cosmetic Changes
  • Anaesthesia Risks


What if Breast Cancer Surgery is Delayed?

Delaying surgery can allow the cancer to grow and spread, which might limit the effectiveness of breast-conserving surgery and require more extensive treatment. For some types of breast cancer, delays can decrease survival rates, especially if the cancer is aggressive or already advanced.


Decisions about the timing of breast cancer surgery should be made in consultation with a healthcare team, considering all medical, personal, and logistical factors. In some cases, immediate treatment may not be necessary; however, for aggressive cancers, prompt surgery is crucial for optimal outcomes.

Share by: