Breast cancer develops from the uncontrolled growth of various cells that make up the breast tissue. It can occur with or without an inherited genetic abnormality. As in the development of cancers in other tissue, both genetic and environmental influences probably play a part. Certainly, smoking and obesity are associated with an increased risk of developing breast cancer.
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, particularly in the armpit or spread to other parts of the body.
Self-breast examinations, breast examination by doctors, ultrasound or mammograms can detect breast lumps or cancers. Following this a “triple test” should be completed before definitive treatment. The “triple test” (history, examination, mammogram plus or minus ultrasound, and tissue diagnosis from a biopsy) has been shown to be very accurate in determining whether a breast abnormality is a cancer or not.
Breast cancer is generally treated with a combination of surgery, hormone therapy (blocks some hormones), radiation therapy (use of high-energy rays) if required, chemotherapy (use of certain drugs). Deciding on the appropriate type of surgery for you will depend on the stage of cancer, type of cancer and the long term benefits of other treatment.
The two main types of breast cancer surgeries include:
The various types of mastectomy procedures include:
In some cases the patient can decide between a mastectomy and wide local excision. With a small breast cancer that can be removed with a clear margin of healthy tissue and leave a cosmetically satisfactory result a wide local excision and adjuvant, (post surgery), radiation therapy is as effective as mastectomy in local control of breast cancer.
Lymph node dissection: The removal of the lymph nodes is an important step in breast cancer surgery to help doctors and patients decide on what further treatment is beneficial. If breast cancer spreads it usually spreads first of all to lymph node in the axilla (arm pit). Checking for lymph node spread is part of staging breast cancer disease. It can be done by removing the sentinel lymph node which is the first lymph node, or nodes to which the cancer cells spread (sentinel lymph node biopsy) or removing all the lymph nodes in the axilla so the pathologist can check them for cancer cells.
Following the removal of breast tissue, the breasts can be reconstructed to achieve a similar shape and size of the original breast/s. The surgeon may perform reconstruction either during the surgical procedure or a few months after the procedure. Breast reconstruction can be performed with either an implant technique or patient tissue technique.
The nipple can also be reconstructed using skin over where the breast was, tissue transplanted from another part of the body or a skin substitute, or by having a nipple tattooed on the reconstructed breast.
Related surgical techniquesRisk reducing surgery to remove the ovaries may be necessary in inherited forms of breast cancer to lower oestrogen levels in the body and so reduce the chance of triggering the development of breast cancer.
Mastectomy, wide local excision and lymph node surgery are done under a general anaesthetic. The patient is completely asleep and feels no pain. The length of stay usually depends on the extent of surgery and the patients need to be in hospital. Just because a patient has a drain in tissue after surgery doesn’t mean they have to stay in hospital. Breast care nurses are wonderful at following patients throughout their whole treatment and can monitor and remove drains from patients in their own homes.
Pain relieving medication is an important part of post operative care. The surgeon and anaesthetist will usually, as a team, make sure patients have a comprehensive pain management plan. Wound dressings are water proof to allow patients to shower and can be removed according to the surgeon’s instructions. Sterile dressings can be left in place for days without any risk to wounds. A special surgical bra can be used to hold the bandages in place and may help to relieve discomfort. Patients may experience tingling, numbness or discomfort in the armpit if lymph node surgery has been performed. Any bruising usually settles after a few days. After surgery, physiotherapists usually play an important role in supervising exercises to help prevent arm stiffness and loss of mobility if a patient has had lymph node surgery. These exercises can be continued at home.
Patients can usually resume normal activities a few weeks after mastectomy, but may require only a few days of rest after a wide local excision.
As with any surgery, breast cancer surgery involves potential risks and complications. Apart from anaesthetic risks they may include: