This is also known as lumpectomy, segmentectomy or wide local excision. This procedure means that the cancer is removed together with a margin of healthy breast tissue. The rest of the breast is left and not removed. |
If the surgeon is unsure how wide a margin is required the margin can be checked by testing the edges. A pathologist who is in the operating theatre looks at the tissue by a technique that freezes it and then uses special stains. This gives the surgeon the information required . In some cases a frozen section may not be possible and the margin clearance will not be known till the formal histology report is received. This usually takes 48 hours. Sometimes a frozen section can be done on the lump itself to confirm that it is a cancer. Where possible, every effort is made to confirm the lump is a cancer before the operation so complete breast cancer surgery can be planned avoiding the need to have more than one operation (this is known as a one stage procedure). Cosmetic incisions are made and in most cases this means the incision is around the margin of the areola. In time, this type of scar is virtually invisible. Sometimes the incision is made at the edge of the breast and if this is the case it is done as unobtrusively as possible.
Lymph node dissection
This is usually a standard part of all breast cancer surgery. It is done to obtain information on whether the breast cancer has spread to the lymph nodes. As a rule if breast cancer spreads beyond the breast it generally is trapped in the axillary (armpit) lymph nodes first. There are 25 to 30 lymph nodes in each armpit. With lymph node dissection usually about one half to two thirds of the lymph nodes are removed. There are enough lymph nodes left to carry on their usual function which is to fight infection locally. The surgeon cannot tell how many are removed at the time of surgery as the lymph nodes are buried in fat. Unfortunately, in removing the lymph nodes the skin nerves giving sensation to the underneath of the upper arm and armpit are cut so that after the operation the patient may be aware of numbness in this area and sometimes 'nerve' pain after the operation. The numbness and nerve pain does improve and even if there is not 100% recovery the body adjusts to this so that it is not a long-term problem. If lymph nodes are removed following the operation there will be a plastic tube left in the armpit and this will drain under suction to a plastic bottle for usually two days. The plastic bottle is easily portable and can be attached to clothing through means of a cloth bag. In a few cases some people will get a temporary build up of fluid in the armpit once the bottle is removed. It literally feels like a golf ball sitting in the armpit and this can be easily drained with local anaesthetic.Physiotherapy exercises
If the lymph nodes are dissected it means there will be discomfort in moving the arm but it is important to follow instructions regarding exercises (see section on Physiotherapy). This will ensure that you do not end up with a frozen shoulder.
Everyone recovers from an operation at different rates. Minimum time off work is usually one week. More realistically, two weeks should be taken off before returning to work. Hospital stay is usually one or two nights but in some situations it is possible to do this type of surgery as a day-case procedure.
When you leave hospital you will have a thick pressure bandage over the breast. This can be removed after two days and a light dry dressing can be applied and changed as required. The surgeon uses layers of dissolving stitches under the surface. Consequently there is very little tension on the skin layer therefore steristrips (little paper sticky tapes) are used to close the skin incision. These steristrips should be left untouched and dry for a week Any sticking plaster remaining on the breast can be removed with a solvent such as methylated spirits or nail polish remover. It is important to keep the area dry for one week following the operation. If you inadvertently get it wet dry the area off with a hairdryer and reapply a clean dry dressing. Once the wound has healed (one week after the operation) the steristrips are removed. Micropore tape (purchase from your local pharmacy) should be placed over the breast scar for four to six weeks and changed as required, perhaps twice a week. This ensures the skin edges 'knit' together and cosmetically achieves a beautiful result. You do not have to keep changing the tape after bathing as it can dry on the skin. The armpit scar does not require micropore tape.
Only one or two women in every 100 will develop a post-operative complication such as a wound infection or haematoma (bleeding in the wound). If an infection develops the area will become painful, red and swollen. If there is bleeding into the wound the area will become swollen and painful. Generally you should expect comfort levels to improve each day and if for any reason the reverse happens notify St Marks Breast Centre. Both complications are easily treated.
This will be discussed in detail later. Radiotherapy is usually mandatory when women have a partial mastectomy. The 'Rule of Five' applies - radiotherapy begins usually about five weeks following the operation for five working days for five weeks for about five minutes a day. The radiotherapy 'sterilises' the breast tissue that remains and this reduces local breast cancer regrowth. Generally women who have mastectomy do not need to have radiotherapy but in some cases it is required. Your surgeon will talk to you about this once the histology report has been received.Link to St Marks Breast Centre Online