BREAST ONCOLOGY INFORMATION

• breast conserving surgery
In this procedure, variously known as lumpectomy, wide local excision, quadrantectomy or partial mastectomy, the pre-cancer or cancer is removed together with a surrounding margin of normal breast tissue. This can often be accomplished through a discrete incision placed around the areola. By mobilising the breast tissue under the skin the appearance from the resultant volume deficit can be minimised. An uninvolved (clear) margin is important to prevent recurrent disease in the future. Because of this it is sometimes necessary to recommend further surgery once the histology report is available. You should plan on a hospital stay of one to three nights depending on whether or not axillary surgery is planned. Radiotherapy is almost always recommended afterwards to the breast. 

• mastectomy
A mastectomy means that much of the breast skin and all the breast tissue is removed. If appropriate a new breast can be reconstructed, ideally at the time of surgery (see Breast Reconstructive Surgery). If reconstruction is not performed a flat scar overlying the chest wall will be the result and an external prosthesis can be worn inside the bra. Lymph node dissection is usually performed at the same time but this is not always necessary. You should plan on a hospital stay of one to three nights. Radiotherapy is usually not a requirement postoperatively, although this is assessed on an individual basis. 

•lymph node dissection
This is a standard part of breast cancer surgery unless the diagnosis is pre-cancer (DCIS). It is undertaken both to determine (stage) whether the breast cancer has spread to the lymph nodes and to remove any affected nodes. As a rule if breast cancer spreads beyond the breast it is trapped in the axillary (armpit) lymph nodes first. There are, on average, 15-25 lymph nodes in each armpit. The majority of people are suitable for a sentinel node biopsy rather than an axillary clearance. 

• recovery time
Everyone recovers from an operation at different rates. Whilst the majority of women feel essentially back to normal after a couple of weeks, four to six weeks should ideally elapse before returning to work particularly if axillary surgery is included. Resuming too quickly potentially delays the ultimate recovery of full fitness. Gentle exercise during convalescence is encouraged and as long as it does not hurt you will not do any damage.

Axillary surgery is undertaken for two main reasons. Firstly, to determine if any cancer has spread to the lymph nodes (staging) and secondly, to ensure removal of any such affected nodes and thus reduce the chance of local disease recurrence.


1. A complete clearance of the axilla (a level III dissection). This involves removing all the lymph nodes and may necessitate dividing small pectoralis minor muscle, although this does not result in any demonstrable weakness. The dissection is continued internally to the root of the neck and usually 20 or more nodes are removed.

2. A level I/II dissection. This involves removing the majority of the nodes, including those behind the pectoralis muscle without dividing pectoral minor and removes, on average, 10-20 nodes.

3. A level I dissection. The lower axilla is dissected and about half the total nodes are removed up to the edge of pectoralis minor.

4. An axillary sample. Six or more nodes 'cherry picked' from the level I area.

5. Sentinel Node Biopsy.

6. No axillary dissection


• recommendations

Current best practice suggests a sentinel node biopsy in the first instance or, if there is known nodal involvment from cytology, a level I/II axillary dissection should be performed on all patients with invasive cancers. There is no clear evidence that more extensive surgery is of benefit, except in a few circumstances, and this full clearance is associated with a higher rate of post surgical side effects, especially arm swelling (lymphoedema) and shoulder stiffness. 

Patients with ductal carcinoma-in-situ (DCIS) alone should not undergo an axillary node dissection; although in some circumstances a sentinel node biopsy is indicated. This is assessed on an individual basis and should be discussed with you.


• sentinel node biopsy

In an effort to minimise the morbidity (arm swelling, stiff shoulder and altered sensation) associated with standard axillary surgery contemporary practice is moving towards identifying and removing only the key (sentinel) node/s. Many international studies have shown the sentinel node can be correctly identified in more than 95% of cases and, if clear of tumour, the likelihood of any other (i.e. non-sentinel) nodes being involved is less than 5%. 

The procedure involves injection of a radioisotope in to the breast. The overall radiation involved is less than one chest X-ray and the vast majority of the dose is removed with the tumour and any residual activity is depleted within 36 hours of surgery. If used, the blue dye can stain the skin leading to a temporary tattooing effect, which can last for weeks or even months. Urine can also be tinged with blue for several hours after surgery. Cases of allergic reaction to the blue dye have been reported very rarely. If the sentinel node/s are positive an operation to remove the remaining lymph nodes will be recommended. 

Surgery that aims to maintain quality of life and an acceptable breast appearance whilst at the same time being uncompromising on oncological effectiveness.  The origins of oncoplastic surgery date to the 1980s with the rise of breast conserving surgery instead of a mastecomy as a surgical option. In more recent years the utilisation has been extended with the use of neoadjuvant chemotherapy (prior to surgery to shkink the tumour). There are three main techniques:


• glandular redistribution

• mastopexy / reduction mammaplasty

• volume restoration