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Breast Surgery

    Tomorrow Made Better - Breast Surgery
  • What is breast surgery?

    Breast surgery is a form of surgery performed on the breast to remove a lump that may be noncancerous (benign) or cancerous.

    There are different kinds of lumps in the breast. Fortunately, 80% of breast lumps are benign and not cancerous. Benign lumps like cysts, fibroadenomas and fibrocystic breast change are harmless and do not increase the risk of breast cancer. However, other lumps, such as intraductal papillomas and Phyllodes tumours, may harbour the risk of cancer, and need to be removed. It is important to distinguish whether a lump is benign or an early stage cancer, as early detection and treatment of breast cancer increase the chance of a prompt and good recovery.

    Doing a biopsy and examining the cells from the tumour is the only way to rule out a cancer. With today’s modern techniques, breast biopsy is usually minimally invasive and can be done in less than half an hour under local anaesthesia.

    Biopsies of breast lumps

    Checking your breasts regularly for lumps or unusual tissue texture is important. If you discover a lump in your breast, visit your doctor as soon as possible to get it checked. Your surgeon may use any of the following day surgery options when taking a biopsy of your breast lump:

    Core needle biopsy

    This procedure is done under local anaesthesia and takes about 10 – 15 minutes. Your surgeon will insert a needle to draw a sample of the affected tissue to be sent to the lab for analysis. This is usually done with the assistance of imaging technology to provide better accuracy.

    Vacuum-assisted needle biopsy

    This procedure is performed under local anaesthesia and allows your surgeon to remove the entire lump in one setting. Using a cutting mechanism and assisted imaging technology, your surgeon will cut up the tissue and draw it through the opening of the needle using a vacuum. This procedure usually takes around 20 – 30 minutes. The removed tissue is subsequently examined under the microscope. If the tissue is benign, you don’t need to undergo a second surgery.

    If the biopsy tests reveal a cancer, your doctor will evaluate your condition and suggest the most suitable treatment for you.

    Surgery for breast cancer

    Breast-conserving surgery

    A breast-conserving surgery (BCS) such as lumpectomy removes the cancer and tissue surrounding the tumour, but not the entire breast. With data showing equivalent survival results between BCS and mastectomy, more women with early stage breast cancers can safely opt to preserve their breasts. Achieving complete cancer removal with clear margins is key to this surgery.

    Patients taking this option should have tumours that are small in relation to the entire breast size, so that a good breast shape and size can be preserved. Radiotherapy is likely required after BCS. Precise localisation of the tumour during this type of surgery minimises the amount of breast tissue that needs to be removed. If the tumour is detected only with imaging and cannot be felt, a radioisotope marker or thin wire may be inserted prior to surgery to mark and locate the area to be removed.

    Breast oncoplastic surgery

    Breast oncoplastic surgery combines the techniques of oncologic surgery (to remove the cancer) with plastic surgical techniques to restore the aesthetics of the breast. The use of these techniques in BCS allows removal of larger tumours while achieving better breast cosmesis and symmetry.

    These techniques include the use of well-placed incisions and reshaping the remaining breast tissue after tumour removal, in order to minimise scarring and deformities. Breast and nipple symmetry may be restored by doing a simultaneous breast reduction or breast lift. With these myriad of techniques, good oncological clearance is achieved without the need for mastectomy.

    The choice of technique used is different for each patient, and is tailored depending on the tumour size and location, and the size and shape of the breasts.

    Partial breast reconstruction

    Partial breast reconstruction is a tool for women with larger tumour to breast ratio, where the volume of remaining breast tissue may not be adequate following tumour removal, resulting in deformity. In such cases, adjacent tissue from below the breasts or the chest wall may be mobilised to restore the volume of the breast. These tissue flaps survive on blood vessels that are branches from chest wall vessels and are named perforator flaps.

    Another form of partial breast reconstruction is the omental flap reconstruction. The omental flap is intra-abdominal fatty tissue that is attached to the stomach and spleen. This tissue is mobilised by minimally invasive abdominal surgery and brought out to fill in the defect in the breast. The omental flap usually has more volume and may be used in patients with larger tumour to breast size ratio.

    Mastectomy

    A mastectomy is usually recommended if the size of the cancer is too large or if the cancer involves multiple locations within the breast. Although most do not require radiotherapy after the surgery, radiation treatment may still be advised after surgery if your tumour is >5cm or if your lymph nodes are affected by cancer.

    A simple mastectomy involves removing the entire breast and most of the overlying skin. If you opt for an immediate breast reconstruction, the overlying skin is preserved as much as possible for a more natural appearance. This is termed skin-sparing mastectomy. If the nipple is also preserved, it is a nipple-sparing mastectomy. This skin preservation is possible only when the tumour is not too close to the skin and nipple.

    Full breast reconstructive surgery

    Breast reconstruction or the 'rebuilding' of a new breast following lumpectomy or mastectomy aims at improving a patient’s quality of life, including body image perception and other psychosocial aspects of their recovery.

    When a mastectomy is required, the options of a full breast reconstruction should be made available to the patient. Full breast reconstruction may be performed with implants, or the patient’s own tissue (skin, fat, muscles) from places like the abdomen, thigh or back, or a combination of both. The type of reconstruction depends on the extent of the tumour, the patient’s health and body habitus, as well as her lifestyle and expectations. A detailed discussion between you and your doctor is necessary before the modality of reconstruction is decided upon.

  • Which breast surgery is right for you?

    When deciding which surgery is right for you, consider these factors:

    • Size of the tumour
    • Location of tumour in your breast
    • Size and shape of your breasts
    • Your personal lifestyle and expectations

    When to seek treatment?

    Early detection and treatment of breast abnormalities increase the chances of recovery with minimal disruption to the breast tissue. It’s important to examine your breasts regularly for signs of change and report any abnormal findings to your doctor for an accurate diagnosis and follow-up treatment.

    While treatments for breast cancer are aimed at saving the breast where possible, the ultimate goal is total removal of the cancer and minimising the risk of recurrence. Discuss all your options with your doctor before deciding on the right treatment for you.

  • Breast surgery is a major medical procedure that can cause you to feel anxious. To help ease your worries, it is important to be prepared for your upcoming procedure and be aware of what will happen during and after the surgery.

    Preparing for a breast surgery

    Before your scheduled surgery, you and your medical team will go through a series of preparations, which may include the following:

    • Your doctor will ask about your medical history. Tell your doctor about your past medical procedures and health conditions. Let him know if you have allergies to certain medications. Likewise, tell your doctor about the medicines and supplements that you are currently taking.
    • If you are taking aspirin or any non-steroidal anti-inflammatory medicines, you will be asked to stop your medication a few weeks before your surgery. These medicines may have a negative effect on how your body will respond to surgery. Thus, it is important to disclose all your medications to your doctor.
    • Follow dietary guideline that your doctor will give you. You may be asked to skip meals and limit liquid intake for a certain number of hours prior the surgery.
    • Make sure that you have a companion in the hospital. You will need someone to assist you after the surgery.

    During a breast surgery

    On the day of surgery, the surgeon will mark the incision points on your breast. Afterwards, the nurse will insert an intravenous infusion (IV) line into your hand. Through the IV line, you will be given medication to help you relax. Once you’re in the operating room, you will be given general anaesthesia.

    What happens during a surgery depends on the type of breast cancer operation. Generally, a breast cancer surgery involves the following:

    • The procedure will start with an incision made on your breast. Then, the surgeon will remove the cancer and surrounding tissue. If it is a lumpectomy, only part of the breast tissue will be removed. If it is a mastectomy, all of the breast tissue will be removed.
    • The lymph nodes in your armpit will be evaluated. The surgeon will take and examine a few sentinel nodes. Sentinel nodes are the first few lymph nodes into which a tumour drains. If no cancer is detected from it, there will be no need for removing additional lymph nodes. If cancer is detected, more lymph nodes may be removed.
    • The incision will then be closed using dissolvable stitches.
    • If you choose reconstruction after a mastectomy, your reconstruction may be done right after the surgery or at a later date.

    After a breast surgery

    After the surgery, you will be brought to the recovery room. Your pulse, blood pressure and breathing will be monitored. Once you are stable, you will be allowed to go home on the same day of your surgery, especially for benign conditions. However, if you had undergone cancer surgery, you may have to spend 1 – 2 nights in the hospital, or more, following an immediate breast reconstruction.

    Expect to feel some pain and numbness in the underarm area after surgery. Follow your doctor’s instructions when it comes to taking pain medication and antibiotics. Additionally, follow instructions on how to look after the dressings over the incision area, including change of bandage if needed.

    You may resume your regular diet at home. You may also take a shower a day after your operation.

    Recovery period for a breast surgery

    You should be functional once you are allowed to go home after the surgery. However, you may have to wait for around 2 – 4 weeks after the operation before you resume to your regular activities. Following breast reconstructive surgery, it can take a few more months before you can fully return to your activities.

    Risks/complications of a breast surgery

    While breast cancer surgery is generally safe, it still carries certain risks just like any other surgery. Complications after the surgery include:

    • Infection – Infection at the incision site may occur until the wound completely heals. Contact your doctor if you experience symptoms like swelling or redness at, or discharge from the incision site, or fever.
    • Haematoma – Another complication of breast surgery is a haematoma, a build-up of blood under the skin. This can cause swelling, discomfort and hardness of the incision site. Usually, haematoma can be resolved without treatment. However, if the haematoma is too large, your doctor may need to treat it by drawing blood off with a needle and syringe or through surgery.
    • Seroma – After breast surgery, you may develop seroma, a collection of fluid under the arm, in the breast or the chest wall. Over time, seromas are reabsorbed by the body.
    • Lymphoedema – Swelling of arm, hand or breast area can be a delayed complication of breast surgery. This condition called lymphoedema is usually caused by lymph fluid build-up in the surface tissues of your body. This condition happens only with cancer surgery, and is uncommon within the first few months after surgery.
  • Mount Elizabeth Hospitals specialise in General Surgery. One of our subspecialties is Breast Surgery, a form of surgery performed on the breast to remove a lump that may be benign or cancerous.

    Breast Surgery at Mount Elizabeth Hospitals is led by our capable surgeons who will strategically plan the procedure best suited for your diagnosis. Our general surgeons are skilled at performing complex operations like minimally invasive surgery, open surgery, and robotic surgery. To complement their expertise, the medical team is equipped with technology and equipment for breast surgery.

    To find out if breast surgery is the right treatment for your condition, consult a surgeon at Mount Elizabeth Hospitals. Our medical team will assist you at each step of the process towards recovery and management of your condition.

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