Dedicated to the care of breast cancer and all breast conditions
+27 (0)11 484 0334
info@raynebreastcare.co.za
Parklane Hospital Women’s Wellness Centre
Waterfall Hospital (North): Rooms 210, South Block
 
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Surgery  
In breast cancer management, surgery will take place at some point through the treatment path. Surgery can take place at more than one time, either for diagnosis, treatment or reconstruction. Here are some of the operations that take place for breast cancer:

Sentinel Lymph Node Biopsy
Wide Local Excision or Breast Conserving Surgery
Mastectomy
Surgical biopsy
Axillary lymph node dissection
Reconstruction
Sentinel Lymph Node Biopsy
Often this is the first part of cancer treatment, carried out to see if the cancer has spread from the breast to the glands (called lymph nodes) under the arm. It can happen at the same time as surgery to the breast, or beforehand to better determine what stage the cancer is. On the day of the operation the patient is injected with a radioactive chemical which is not harmful, and the doctor uses a special probe and blue dye to find the first gland the cancer would have spread to (the ‘sentinel’ which means the guard). The surgeon will make a small cut in the armpit under a general anaesthetic and take out this gland. If the cancer is caught in the gland it increases the risk it has spread outside the breast to the rest of the body. This may change the type of treatment and order in which treatments are given. It can also change options for reconstruction.

National Cancer Institure - Sentinel Lymph Node Biopsy
 
Wide Local Excision or Breast Conserving Surgery
This is a ‘lumpectomy’ operation that can take place if it is possible to remove the cancer safely without removing the whole breast. This might be because the cancer is small, or because the breasts are large enough to allow a big area to be removed. Cancer is never taken out alone, it is always taken out with a margin, which acts as a fire break between the cancer and normal breast tissue. It reduces the risk that the cancer may come back in the same place.

There are some important safety measures that have to happen with breast conserving treatment (BCT). The first is that the surgeon must be sure that all the cancer can be removed safely. Then the patient must be able and willing to have radiation treatment, because BCT is not safe if you do not have radiation. Finally it is important that BCT is carried out with help from a surgeon skilled in reconstructive techniques. Most often (in South Africa) this is a different surgeon from the breast cancer surgeon.
 
Mastectomy
The oldest and most well-known method of surgically treating breast cancer is a mastectomy. This is a procedure where the whole breast is removed from the body. Sometimes the breast and skin are removed, and this means that the woman is left with a flat chest and one scar. At other times, however, only the breast is removed, the skin is left behind (a skin-sparing mastectomy)and a reconstructive surgeon fills the pocket with tissue from another part of the body, or with an implant. Sometimes a woman may decide to have both breasts removed during the operation but this is only after intense discussion of all the options, and a realistic assessment of the risk of further cancer in the other breast.
 
Surgical biopsy
Very occasionally a core needle biopsy does not give enough information or is too difficult to carry out. When this happens you may need to have a small surgical procedure to remove the problem area. Less than 20% of breast problems should be diagnosed this way.

If the area is too small or cannot be felt it can be marked by ultrasound guidance, using a wire (a ‘hookwire’) or some dye, placed into the breast at the problem site.

In the operating theatre under a short general anaesthetic, a cut is made to the breast (normally the cut is hidden around the areola or under the breast) and the area removed for Xray, to make sure the right area has been taken, and then for diagnosis.
 
Axillary lymph node dissection
If the cancer has spread to the glands, all of the glands under the arm will need to be removed. Unfortunately this can cause some pain and stiffness around the arm after the operation, and in 1 out of 10 ladies, if many nodes are removed, the arm may swell up after the operation (called lymphoedema) because there is no longer a clear passage for fluid to flow from the arm back to the body. Most often an axillary dissection is done at the same time as the breast operation, through the same cut or a different one. If the sentinel lymph node biopsy is negative however, an ALND may not be required.

New data suggests that some women may not need to have an ALND; even if their glands are positive. This may change surgical practice in the future, but at present further research is required.
 
Reconstruction
All patients who have breast surgery should have the opportunity to have reconstruction. This surgery can restore two equal breast mounds to a woman’s chest. This may be part of breast conserving surgery or after a mastectomy, either at the same operation or at a later date. Plastic surgeons can use tissue from other parts of the body to reconstruct the breast and they may also use prostheses, made of materials such as silicon, to give the shape of a breast under the skin and muscle, if there has been a mastectomy. All women have a right to be considered for reconstructive surgery, even if your operation was a long time ago.
 
 
 
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