Surgery (breast cancer)
This aims to remove breast cancer and may involve:
Breast conserving surgery
This is often referred to as a wide local excision or lumpectomy.
Here the cancer is removed with a 'safety rim' or margin of normal breast tissue around it, and radiotherapy is usually given to the rest of the breast to reduce the risk of recurrence.
Oncoplastic breast conserving surgery
This is when the cancer is removed with a 'safety rim' of normal breast tissue around it, with immediate reshaping and/or remodelling of the breast defect to give a good cosmetic appearance, and in some people to enable better targeting for radiotherapy, which is normally given to the rest of the breast.
Mastectomy
This is the removal of the entire breast, the skin and the nipple. If you have a mastectomy you will be fitted with a temporary, soft prosthesis (a comfie) before discharge. Once the scar is healed (a minimum of six weeks) you will see a breast cancer clinical nurse specialist for a semi-permanent, silicone breast prosthesis (breast form).
A mastectomy may be performed in conjunction with breast reconstruction where appropriate.
Breast reconstruction
This may be done at the same time or at a later date (depending on your options) and may involve keeping the majority of the breast skin (skin sparing mastectomy), or even the nipple (nipple sparing mastectomy) if possible.
Following breast reconstruction, the breast cancer clinical nurse specialist can provide a ‘shell’ prosthesis to restore symmetry if the reconstructed breast is larger or smaller than your natural breast.
Axillary (or underarm) surgery in breast cancer
Lymph glands or nodes in your armpit may also need to be removed, to find out if the cancer has spread to the lymph nodes, and to help decide if further treatment after surgery may be helpful.
Sentinel lymph node biopsy
Some patients require a sentinel (first draining/gate keeper) lymph node biopsy, where a few lymph nodes (usually between one and four) are removed. The number of nodes removed varies in each individual. Before your axillary surgery you will need a pre-operative injection into the breast to identify this drainage through the lymph channels to the first draining lymph nodes. You may also have an injection of blue dye immediately before the operation to help locate these lymph nodes. The removed lymph nodes are analysed with the breast tissue. If they contain cancer, depending on individual circumstances you may be recommended to have additional nodes removed (this is called an axillary clearance) or to have radiotherapy to the armpit as part of your treatment.
Axillary clearance
If the initial assessment shows cancer cells in the lymph nodes prior to surgery you may be recommended to have a complete clearance of the axillary (armpit) lymph node tissue. If there are cancer cells detected in the sentinel/gate-keeper lymph node(s), depending on individual circumstances you may be recommended to have an axillary clearance as part of your treatment.