Breast Cancer Surgery
Breast cancer surgery involves the surgical removal of a breast tumour and a portion of the surrounding normal tissue to prevent its spread to the other parts of the body. Breast cancer develops from the uncontrolled growth of abnormal breast cells. It is caused due to a genetic abnormality, which can be inherited, or can occur due to aging and wear and tear of the body.
Breast cancer generally begins in lobules (milk-producing glands) or ducts (milk-draining passages extending from the lobules to the nipple). Breast cancer can sometimes occur in the fatty and fibrous breast tissues. If left untreated, the tumour cells may invade the nearby healthy breast tissues and into the lymph nodes of the underarm, which can spread to other body parts.
Diagnosis
Self-breast examinations, mammograms and other imaging studies and biopsies can be ordered by your doctor to detect, diagnose and monitor breast cancer.
Before Admission
Before you Come to Day Surgery
Prior to your admission, please send your Pre-Admission form to the hospital.
- Contact your health fund to confirm your cover.
- Ask your doctor about your medications and what to take before and during your hospital stay.
Prior to admission we ask that you:
- Shower
- Abstain from food and drink in the preceding 6 hours, unless otherwise advised by your doctor
- Wear comfortable, loose-fitting clothing
- Bring a non-underwire bra that you could sleep in comfortably
- Arrange for someone to drive you or accompany you home in a taxi
What to bring on the day:
- Correspondence from your doctor(s)
- Past medical history from your GP
- List of your current medications and dosage information
- Medication for the treatment of diabetes
- X-rays and test results relevant to your procedure
- Health fund details and settlement of outstanding fees due on admission
- Medicare card, pension card or other concession cards such as veterans’ affairs entitlement card and health fund details. (Please confirm your private health insurance status with your health fund)
What NOT to bring:
- Valuables
- Wheat packs as they can’t be placed in the microwave
- Hot water bottles and electric blankets
When you arrive:
Please check in at the reception desk located in the main entrance foyer. You will then be directed to the Admissions Centre. Occasionally there is an unexpected delay because of a more complex case or an emergency. We suggest you bring a book or other diversion to pass the time should this occur. We will keep you informed about any delays.
How long will I be there?
You will need to be in hospital for half a day or 4 hours after your surgery. If you have morning surgery you can leave in the afternoon. If you have afternoon surgery, you can leave in the evening.
Are there any rules for discharge?
You will only be allowed to have day surgery if you can be collected by and go home to a responsible adult who can be with you for 24 hours after your surgery. If not, you will be admitted overnight.
Surgical procedures
Breast cancer is generally treated with a combination of surgery, hormone therapy (blocks some hormones), radiation therapy (use of high-energy rays) and chemotherapy (use of certain drugs). Deciding on the appropriate type of treatment for you will depend on the stage of cancer, type of cancer, and its biological profile.
The two main types of breast cancer surgeries include:
- Lumpectomy or breast-conserving surgery: This involves the removal of only the tumour along with a small margin of the surrounding breast tissue.
- Mastectomy: involves removal of the complete breast tissue.
The various types of breast conserving surgery include:
- Simple wide local excision
- Extended wide local excision with tissue displacement or replacement (“fill in the hole with miniflaps or other tissue”)
- Therapeutic mammoplasty ( wide local excision combined with breast reduction)
The various types of mastectomy procedures include:
- Simple or Total Mastectomy: Your surgeon will remove the entire breast and sometimes the lymph nodes from the armpit by making a 6 to 7-inch long elliptical cut starting from the inside of the breast, close to the breast bone, and continuing up and out toward the armpit.
- Skin-Sparing Mastectomy: Your surgeon will cut an opening around the nipple and areola to remove the breast tissue. Most of the breast skin is preserved with this technique, which is generally lost in traditional mastectomy. It offers the advantage of negligible scarring and provides the best option for immediate breast reconstruction.
- Nipple-Sparing Mastectomy: Your surgeon will make an incision in the fold of skin under or to the side the breast, or around the areola, where the cut cannot be easily seen after healing, and will spare the nipple.
- Preventive/prophylactic or risk-reduction mastectomy: If you are genetically predisposed and have a high risk of developing breast cancer, you may choose to have preventive surgery. A simple mastectomy or nipple-sparing mastectomy can be performed.
In some cases, you can choose between mastectomy and lumpectomy. If you have only one cancerous site, less than 4 cm of tumour and a clear margin of healthy tissue, lumpectomy with radiation is as effective as mastectomy.
Lymph node dissection: The removal of the lymph nodes is an important step in breast cancer surgery as the cancer cells can spread to the other parts of the body through the lymph. Your surgeon can remove five to thirty lymph nodes or sentinel nodes, which are the first lymph nodes into which the cancer cells can spread.
Breast and nipple reconstruction
Following the removal of breast tissue, the breasts can be rebuilt to achieve a similar shape and size of the original breasts. Your doctor may perform reconstruction either during the surgical procedure or a few months after the procedure. Breast reconstruction can be performed in two ways:
- Using silicone implants to replace the breast tissues
- Replacing the breast tissue with tissue transplanted from your stomach, buttocks, back or thigh
The nipple can also be reconstructed using tissue transplanted from another part of your body or a skin substitute, or by having a nipple tattooed on the reconstructed breast.
Related surgical techniques
Prophylactic ovary removal - preventive surgery where ovaries and fallopian tubes are removed to lower oestrogen levels in the body so that the chances of triggering the development of breast cancer are lowered or due high risk by carrying the BRCA1 or 2 gene.
Post-operative care
Lumpectomy and sentinel node biopsy can be done as a day stay procedure but most patients prefer to stay overnight. Mastectomy requires a few days in hospital. When dissection is involved or a more complex surgical breast technique is used such as a reconstruction, you will be required to stay in the hospital for a few days.
You will be prescribed medicines to relieve pain. You will be discharged with an external drainage device to collect fluid from the surgical site. The stitches are dissolvable and the dressings are waterproof to showering. You should keep the incisions clean and dry for a week after the surgery. A post surgical bra is recommended with no underwire to wear post operatively and can be obtained from David Jones, Target and other lingerie shops. You may experience tingling, numbness or discomfort in the armpit. You will be bruised and lumpy over the breast. The bluish-black colour and swelling will lessen after a few days. You will be instructed to begin arm exercises on the next day after surgery to prevent stiffness, and to increase the exercise routine after consulting with your doctor.
You will be able to continue with your normal activities a few weeks after mastectomy, but may require only a few days for lumpectomy.
Risks and complications
As with any surgery, breast cancer surgery involves potential risks and complications. They may include:
- Haematoma (accumulation of blood in wound) and seroma (accumulation of fluid in wound)
- Excessive bleeding
- Lymphedema (accumulation of lymph fluid in the arm)
- Wound infection
- Wound breakdown
- Nerve pain
- Scar formation in the armpit
