What are the surgery options?

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. 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 2 or 3 days and a further 2 to 3 weeks for healing. You shouldn’t drive for 1 to 2 weeks and you will 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.

Mastectomy

A total mastectomy is the removal of all the breast tissue. Unless a reconstruction is performed at the same time as the mastectomy, the skin will be removed as well. 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.

Breast reconstruction

Most women who opt for breast reconstruction have it done at the same time as the initial surgery. You can, however, have a reconstruction at any time after your initial operation. Some women choose to wait a few years.

Implants

There are two different types of implants still mainly used today. One is filled with silicone and the other with saline (water).

If you are considering getting an implant, you should talk to your surgeon about the pros and cons of each type, how they will feel, and how they will be placed in the body (either under the chest muscles or on top).

It will take about 2 to 3 weeks for the wound to heal.

Lat Dorsi

This operation is used for women who are more active and generally have smaller breasts.

The Lat Dorsi muscle is transferred from the back and if necessary an implant is also used to fill out the breast flap.

Recovery from this operation is a hospital stay of 5 to 6 days with a further recovery of a few weeks to allow for the wound to heal and your body to adjust to the new location of the Lat Dorsi. You should avoid lifting or major physical activity for 4 weeks following the surgery.

TRAM

This form of reconstruction is becoming very popular due to the fact that the woman’s own tissue is used. Muscle, fat, and skin are transferred from the abdomen to the breast.

Recovery from this form of operation takes longer. The hospital stay will be 5 to 7 days and expect a further 5 to 7 weeks of healing. You will have to avoid lifting, driving, or major activity during this initial recovery period. Slow and steady is the key for this surgery.

Prophylactic Mastectomy

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 further cancer. This is called bilateral prophylactic mastectomy and has been proven to reduce the chances of high-risk women developing further 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 removal

The surgeon sometimes removes some lymph nodes from the armpit to see whether the cancer has spread beyond the breast. This can help when planning treatment. Recovery will involve no heavy lifting, massage of the arm, special care of the arm and physiotherapy to help the muscles to recover.

A side effect from lymph node dissection is Lymphoedema. Usually this occurs in 10% of women. This can be a debilitating side effect where the arm cannot eliminate all of the excess fluid. This fluid builds up and the limb becomes swollen and uncomfortable. A pressure bandage can be worn and massage used to help alleviate the discomfort.

Sentinel Node Biopsy

This involves removing the lymph node that the cancer is draining into but first it’s important to find out which node is the right one. The correct node is located by injecting a blue dye and a radioactive substance into the breast.

The removal of the sentinel node may help avoid removing further lymph nodes. This procedure is currently being trialled throughout the country.

Lymphoedema

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.

Events that are known to trigger the beginning of lymphoedema include:

air travel, due to the changes in air pressure
injury to the limb e.g. sprains, fractures, wounds or skin punctures, e.g. mosquito bites, injections, blood tests in the susceptible limb
burdening the limb by carrying heavy bags on the susceptible hand or arm.
infections in the skin on the susceptible limb
exposure to excessive heat including sunburn
constriction on the limb from blood pressure tests, tight clothes, and jewellery or sleep position.

Pressure garments are used to help treat this condition.

What are the surgery options?

About Breast Cancer