Surgery

The type of surgery needed to treat breast cancer depends on the type of cancer, the size of the cancer, the amount of surrounding tissue that needs to be removed and the size of your breasts. An area of healthy tissue around the cancer is removed along with the cancer.

Breast conserving surgery

If the area to be removed is small in relation to the size of the breast conserving surgery can be performed. After breast conserving surgery (lumpectomy, wide local excision, quadrantectomy where a quadrant of breast is removed) you will usually be offered radiotherapy to the breast to prevent cancer coming back in the same breast. Studies have shown that breast conserving surgery followed by radiotherapy is as good as having a mastectomy. Scar may be placed directly over the lump or may be hidden around the nipple area. After the surgery the tissue is sent for testing and if the tissue shows cancer cells at the margin there is a possibility that you may need a second operation to take more tissue.

Wire guided wide local excisions

Cancers detected on screening mammograms or detected on ultrasound scan are difficult to feel. You may have a wire placed under x ray control or under ultrasound guidance to guide the surgeon to remove the lump. This is called wire guided wide local excision.

Mastectomy

If the cancer is large in relation to the size of the breast the cancer, or where there is more than one cancer within the breast then you may need complete removal of the breast including the nipple. This is called mastectomy.

An external prosthesis can be used in the bra or you can consider delayed reconstruction after completion of treatments.

Some women choose to have their breasts reconstructed at the same time as the removal of the breasts (immediate reconstruction). In these patients the skin of the breast including or excluding the nipple is retained to create a pocket for reconstructing the breast. This is called skin sparing mastectomy if nipple is excised and subcutaneous mastectomy if nipple is preserved.

Therapeutic mammoplasty

In women with large or droopy breasts wide local excision (lumpectomy) can be performed as a part of breast reduction or breast lift.  As a symmetrisation procedure this usually involves surgery to the opposite breast at the same time, though in some cases this is delayed to a later date. This also helps avoiding side effects of radiotherapy in women with large breasts.

Lymph nodes

Breast cancer patients in whom preoperative tests did not detect the involvement of the lymph glands with cancer are recommended surgery to remove some (1-4) of the sentinel lymph glands from under the arm on the same side as the breast cancer. The sentinel lymph glands are the first lymph glands that cancer cells reach if they have spread. Sentinel nodes are identified using dual technique (radioactive tracer and blue dye0 or blue dye only technique.

The nodes usually (1-4) thus removed are sent to the pathologist to determine whether breast cancer cells have reached them. This is done at the same time as the breast operation in most cases.

The result of the node biopsy is usually known at the time of the operation or 1-2 weeks after surgery. If your node has cancer cells in them you will usually be offered either axillary clearance (removal of all the lymph nodes from under the arm) or radiotherapy.