Mastectomy involves the use of an elliptical incision over the breast to excise some of the skin overlying the breast and the nipple and the areola as well as the underlying breast tissue. This results in a flat chest on that side with a straight scar that curves up in towards the armpit. This procedure is usually performed to treat large breast cancer, multifocal breast cancer or inflammatory breast cancer.
Skin sparing mastectomy is the removal of the breast tissue including the areola and nipple through a circular incision around the areola. Sometimes it is also possible to keep the nipple and areola as well ( nipple-sparing mastectomy). This procedure is performed when Breast Reconstruction is considered at the same time. preservation of the breast skin reduces the scars on the new breast and helps improve the cosmetic result of the reconstruction. The procedure is proved to be oncologically safe and comparable to old-style mastectomy
When treating breast cancer it is essential to evaluate whether cancer cells have spread outside the breast. the axillary lymph nodes are likely to be the first place where cancer cells can spread to. During your assessment an ultrasound scan of the armpit will be performed, if this shows normal Lymph nodes a sentinel lymph node biopsy will be recommended to examine them under the microscope. If the lymph nodes were seen abnormal on the ultrasound scan then a biopsy with ultrasound guidance will be performed to assess the abnormality by a pathologist. Axillary node clearance is usually recommended when this biopsy showed cancer cells.
Sentinel lymph node biopsy is the removal of the sentinel lymph node. The sentinel lymph node is the first lymph node or nodes to receive lymphatic drainage from a tumour. It is the first lymph node the cancer is likely to spread to from the tumour. A radioactive substance and/or blue dye is injected near the tumor or under the areola. The substance or dye flows through the lymph ducts to the lymph nodes. The first lymph node or nodes to receive the substance or dye is removed. A pathologist views the tissue under a microscope to look for cancer cells. If cancer cells are not found, The rest of the lymph nodes in the armpit will be left. However, if cancer cells are found in the sentinel node, it may become necessary to remove more lymph nodes.
Axillary node clearance is the removal of all the lymph nodes in the armpit. It is done when the pre-operative assessment of the armpit showed cancer cells in the lymph nodes or sometimes when the sentinel lymph node confirmed cancer cells.
This procedure is more extensive than sentinel lymph node biopsy and is associated with a higher risk of complications. The main complications are Lymphoedema and shoulder stiffness. Click here to learn more about lymphoedema. Other patients may experience numbness and pain in the upper inner aspect of the arm.
Also, see for further information: Treating breast cancer
Lumpectomy can not be offered to women who have multiple breast tumours (Multifocal breast cancer). In some women, who have a large tumour in a relatively small breast cup, upfront chemotherapy or Endocrine therapy may be offered to shrink the cancerous lump and then perform a lumpectomy.
This is a new technique of breast-conserving surgery, It is an operation that is frequently performed by Mr Salhab, It is offered to women who have large tumours in a relatively large breast cup. The technique involves removal of the breast cancer lump with normal breast margin and reshaping of the breast by reducing and uplifting the breast. Reduction of the other breast is usually required to achieve breast symmetry. surgery on the healthy breast can be done at the same time of cancer surgery or at a later stage. This will be discussed with you in details prior to your surgery. Therapeutic mammoplasty can also be useful for women who have a relatively small tumour in a very large breast and who were contemplating breast reduction surgery in any case.
Therapeutic Mammoplasty has potential advantages such as it enable the surgeon to remove larger amount of breast tissue, this may reduce the risk of further surgery to clear the excision margin. Also, it can help with the delivery of radiotherapy. It is perhaps easier and safer to administer radiotherapy to the smaller breast than to a larger one.
However, there are some disadvantages to this approach that are important to understand. Therapeutic mammoplasty causes more scars to the skin of the breasts, these scars will fade well with time in the majority of women, but for some, the scars remain quite visible. As this procedure is a bigger operation compared with lumpectomy, there are higher risks for the development of postoperative problems, such as infection or delayed wound healing. If these problems were to develop then there is a chance that any further medical treatment for breast cancer might be delayed (chemotherapy and radiotherapy). Such delay will almost certainly not impair the chances of treating breast cancer successfully.
Breast Cancer Surgery
The aim of breast cancer surgery is to remove the breast tumour and some of the surrounding healthy tissue.this is to make sure that all the tumour has been removed and to reduce the risk of breast cancer local recurrence. In addition to surgery performed on the breast, some lymph nodes under the armpit are usually removed as part of the operation so they can be checked for cancer cells. Although breast-conserving surgery can be done for many patients, sometimes the whole breast has to be removed. Mr. Salhab will discuss your suitable surgical options so you can pick the best one that suits you.
A specific operation may be recommended for you based on the size, location, or type of breast cancer. Each surgical option has pros and cons and different side effects, these will be discussed in details so you make a suitable decision
Types of Breast Cancer Surgery
Breast cancer surgeries differ by the amount of healthy tissue that is removed with the tumor. Types of breast cancer surgery include:
The goal of breast-conserving surgery is to remove the breast cancer and maintain the breast. Although the removal of part of the breast may result in a breast deformity or poor cosmetic outcome, there are different oncoplastic techniques that Mr. Salhab uses to minimize breast deformities.
After breast-conserving surgery, there is a chance that the pathologist might find that the tumour is larger down the microscope than initially thought. If that was the case then the margin of excision would be insufficient and further surgery to her breast to achieve an adequate margin of excision may be recommended. The chances of this happening would be approximately in the region of 20 %.
It is important to remember that after the operation radiotherapy would always be recommended to treat the remaining breast tissue. Treatment with radiotherapy will reduce the risk of breast cancer recurrence in the breast.
Types of breast Conserving surgery:
Lumpectomy is also known as wide local excision, it involves removal of the cancerous lump with a rim of healthy breast tissue around it. The aim of breast-conserving Surgery is to leave the majority of normal breast tissue intact so the breast shape is maintained. Lumpectomy is offered to patients with small, early breast cancer.
If breast cancer lump is too small that can not be felt by clinical examination, localisation of the lump by inserting a wire into the breast under ultrasound or mammogram guidance is essential to make sure the diseased area is removed in surgery.
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Mo Salhab MD, MRCS, MS, PG Dip, FRCS
Oncoplastic, Reconstructive & Aesthetic Breast Surgeon