Surgery is often recommended as a treatment for breast cancer, with the objective normally being to remove as much of the abnormal/cancerous tissue as possible, although surgery may also be recommended to find out whether cancer has spread further within the body, or to restore the shape of the breast after cancerous tissue has been removed.
Surgery can either be 'breast-conserving' surgery, where only a section of the breast tissue is removed, or 'mastectomy' where the entire breast is removed. The decision on which is the most appropriate approach is determined by a range of factors, including size of the tumour and any previous treatment outcomes.
Surgery is also often combined with other treatments, such as chemotherapy, endocrine (hormone) therapy and radiotherapy to maximise the effectiveness of the overall treatment program.
The following are common surgical procedures used in the treatment of breast cancer:
Wide Local Excision (Lumpectomy)
This is where a lump is removed from within the breast. Pathology testing on the tissue will indicate whether all of the abnormal cells have been removed or not. If some remain, a further procedure may be required. During the procedure, it may be necessary also to remove some lymph nodes located in the armpit to check whether cancerous cells may have travelled from the breast tissue. This procedure is referred to as 'axillary dissection' or 'sentinel lymph node biopsy'.
In some cases wide local excision may not be possible, in which case a mastectomy may be the best treatment option.
Breast Duct Surgery
Where a patient has experience discharge from a nipple, breast duct surgery may be required. This procedure, also referred to as 'microdochectomy', involves the removal of one or more of the milk ducts. Removal of all of the milk ducts, which prevents the ability to breastfeed, is generally only recommended for patients who are beyond childbearing years.
Localisation and Excision Biopsy
This is different from wide local excision and involves the removal of a small tissue sample from a lump in the breast to find out whether abnormal / cancerous cells are present or not. If abnormal cells are present, a wide local excision may be necessary.
Mastectomy
Mastectomy is the surgical removal of the entire breast. There are many different approaches to mastectomy and our surgeons always discuss the most appropriate options with our patients based on each individual case. The most common approaches are:
- Total Mastectomy - the most common option.
- Radical Mastectomy - where in addition to the breast, the lymph nodes and pectoral muscles are removed. This may be recommended where cancer has spread into adjacent tissue.
- Nipple/Skin Sparing Mastectomy - this option allows some breast reconstruction. It may be performed during the initial surgery or in a separate procedure.
- Prophylactic Mastectomy - Usually only performed as a preventative measure where no cancer has been discovered, but the patient is deemed to be at a very high risk of contracting breast cancer, generally due to a family history of breast cancer.