Following a breast cancer diagnosis, you may be advised to have surgery to remove the cancerous tissue. For many women, their biggest fear is what their breast will look like following surgery, while others just want the cancer out regardless of the cosmetic result. The fact is that if the breast cancer is caught early, most women are able to keep their breast because it can be successfully treated by removing just the area of abnormal tissue rather than the breast itself.
The aims of surgery are to:
- Remove the cancer safely, reduce the risk of recurrance and maximise survival
- Achieve a good cosmetic result and optimise quality of life
- Obtain tissue for pathological staging and to help determine further treatment (this may be more surgery, chemotherapy, radiation therapy, hormonal therapy or a combination of treatments)
Download a 'Surgical Options' leaflet here. You may wish to make notes and discuss the content with your specialist.
Here are some questions you may wish to ask your surgeon
Breast conserving surgery
Whether a lumpectomy or a partial mastectomy is the most appropriate treatment in your case is a decision you will have to make in consultation with your surgeon. A partial mastectomy involves removing a wedge of tissue from the breast around the cancerous area. Usually the nipple is kept. The aim of the partial mastectomy is to remove the cancer but also leave the breast looking as natural as possible.
The length of time it will take you to recover from a partial mastectomy will depend on whether lymph nodes were removed from under your arm at the same time. You should expect a hospital stay of approximately 1-2 days and a further 2 to 3 weeks for healing. You shouldn’t drive for 1 to 2 weeks and you may need to take 2 to 3 weeks off work. If you have had lymph nodes removed, you will be unable to lift anything heavy initially. You will also have a drain under the arm for a few days, removing any excess lymphatic fluid and you should be given a programme of arm exercises to ensure you regain full range of arm movement..
A total mastectomy is the removal of all the breast tissue along with the nipple and areola and a wedge of skin. If a reconstruction is performed at the same time as the mastectomy the skin will be spared . Removal of the skin does not stop the woman from having breast reconstruction later if she wishes. As with a partial mastectomy, an operation removing the lymph nodes under the arm may be performed at the same time. You will be unable to lift anything heavy initially. You will also have a drain under the arm for a few days removing any excess lymphatic fluid. Recovery in hospital will be 2 to 5 days and a further 2 to 4 weeks for healing.
All women after a mastectomy are offered an external prosthesis. This is paid for by the Government and includes grants for bras.
Women who have a strong family history of breast cancer or with genetic mutations may choose to have both of their breasts removed to reduce the chance of developing breast cancer. This is called bilateral prophylactic mastectomy and has been proven to reduce the chances of high-risk women developing breast cancer but it is still not a complete guarantee. Women who have had this procedure will still need to be checked every year.
Lymph Node Surgery
Some lymph node surgery is usual if the breast cancer is invasive. Usually the lymph nodes which drain from the breast lie in the armpit. After removal, they are examined pathologically to determine whether the cancer may have moved beyond the breast and thereby help in the decision regarding further treatment such as chemotherapy, radiation therapy, hormone therapy or immunotherapy, either alone or in combination. If you have lymph nodes removed from your armpit or if you have radiation treatment of that area, you may get lymphoedema, which is a swelling in the arm and hand. It can occur shortly after surgery or years later and is caused by slow or blocked flow of lymph fluid resulting from lymph nodes or vessels being removed or damaged. To avoid lymphoedema, you should take special care to avoid injury or infection by protecting the arm on the side you had surgery. Read more
Sentinel Node Biopsy
The sentinel node(s) is the first lymph node(s) that drains the breast cancer (usually in the armpit). Sentinel node biopsy is the removal of this node(s). The sentinel node is located by injecting a small amount of radioactive substance and/or blue dye into the area of the breast lump and surrounding area. The node(s) is then tested to see if it contains any cancer cells. If cancer cells are present further lymph nodes may need to be removed.
Some women choose to undertake breast construction following a mastectomy. This is a surgical procedure to rebuild the shape of the breast, along with the nipple and areola (the pigmented area surrounding the nipple). Recent advances in reconstructive techniques give more choices for breast reconstruction. Read more