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Oncological breast surgery

This is surgery to remove breast cancer. It may involve:

  • Breast conserving surgery, where the cancer is removed with a 'safety rim' of normal breast tissue around it, and radiotherapy is usually given to the rest of the breast, or
  • Oncoplastic breast conserving surgery, where 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, which is the removal of the entire breast, and can be performed in conjunction with breast reconstruction where appropriate. This may involve keeping the majority of the breast skin (skin sparing mastectomy), or even the nipple (nipple sparing mastectomy, as possible) if in conjunction with a reconstruction, at the same time or at a later date (depending on your options).

Axillary (or underarm) surgery in breast cancer

Some of the lymph nodes in your armpit may also need to be removed, to find out if the cancer has spread to the lymph nodes, and further treatment after surgery may be helpful.

Some patients require a sentinel (first draining) lymph node biopsy, where a few lymph nodes (usually between one and four) are removed.

Before your underarm or axillary surgery typically you will need a pre-operative injection into the breast identifies this drain through the lymph channels to these first draining lymph nodes and helps identify those few first draining lymph. You may also receive an injection of blue dye immediately before the operation to help locate these lymph nodes.

The removed lymph nodes are analysed and if they contain cancer additional nodes will need to be removed. This is called an axillary clearance. The number of nodes varies in each individual.

There are useful links to further information below

If you have a mastectomy, you may also want to have breast reconstruction (see breast reconstruction section).

There are additional treatments that may also be used to treat the breast cancer. These include radiotherapy, endocrine therapy and chemotherapy.

Radiotherapy

Radiotherapy is usually offered if you have had breast conserving surgery of an invasive breast cancer, to reduce the chances of the cancer coming back in the breast. It is also offered to some women with ductal carcinoma in situ (DCIS), where the cells have not developed the ability to invade, and sometimes after mastectomy under certain circumstances. This involves using a type of radiation directly into the breast or surrounding tissues.

This is provided by our breast clinical oncology team and will usually take place a few weeks following surgery once the initial healing process has been completed.

For some people who have had previous radiotherapy for other disease in the upper part of the body or with certain medical conditions, or movement disorders this may not be suitable

Please see our radiotherapy pages and the links below for more information

Endocrine therapy

Endocrine therapy involves taking a tablet for five to ten years after your operation, to reduce the chances of the cancer returning somewhere else. It is also sometimes given for a period before the operation to try to shrink the cancer. For some women who cannot have surgery due to their other medical conditions this may be used alone to help control the cancer.

These tablets work by blocking oestrogen receptors. This type of therapy may be suitable for up to 75% of patients. This will depend exactly on the type of cancer and whether it is sensitive to this type of treatment.

Please see the links below for more information

Chemotherapy

Chemotherapy may be advised for certain cases after a careful discussion of the pros and cons with an oncologist. This will depend on you as the patient, your type of cancer and whether there is a benefit after (or before in some cases) you have been offered your surgical treatment and whether your cancer is suitable for hormone treatment.

Before any chemotherapy we will typically arrange for a CT staging scan to assess whether there is breast cancer anywhere else, this may happen before or after surgery. If there is breast cancer in other areas outside of the breast this is called secondary breast cancer.

There are particular types of breast cancer which are more likely to benefit from chemotherapy treatment this will be discussed between yourselves and the oncology team .

Chemotherapy aims to reduce the chances of the cancer returning both locally (in the breast or chest wall) and elsewhere in the body.

It is an important treatment in some types of breast cancer after surgery to reduce the chance of spread, before surgery in certain types of cancer to help shrink and control the cancer but also in people with secondary breast cancer (breast cancer elsewhere in the body). If this is your diagnosis there is a full team to help support you through.

Sometimes it may help to have chemotherapy before the cancer surgery, to try to reduce the size of the cancer and the chance of spread outside of the breast. This will depend exactly on the type and size of the cancer and will be balanced against your personal risk factors as a patient. This happens a few months before the breast cancer surgery.

Your case will be discussed in our team meeting with the oncologists (chemotherapy and radiotherapy doctors) to see if you may benefit from chemotherapy.

For some patients the benefit of chemotherapy are very clear, for others there is no additional benefit for chemotherapy. There is also a small group in between, where the benefits of chemotherapy are unclear due to the type of cancer. In these cases we may discuss a further test on the genes of your breast cancer to help guide us. This is a genomic test, and at present there are two main ones which we use: Oncotype DX and Prosigna.

We will arrange for you to see a member of the oncology team to discuss any possible chemotherapy.

Please see our cancer pages and the links below for more information.