Breast Surgery

Surgery remains the first line treatment for early breast cancer. Surgical therapy has two components:

• The breast
• Draining lymph nodes (in the arm pit)

The Breast

In our unit, 60% of cases undergo breast-conserving surgery. The principle is to remove the tumour with a surrounding rim of normal breast tissue, while at the same time, achieving an acceptable cosmetic result. Sometimes, a second small operation is required to obtain a clear surgical margin. Postoperative radiotherapy is almost always required after breast conserving surgery.

Some women still require a complete mastectomy because of the pathological nature of the tumour or because the size of the tumour in relationship to the size of the breast would result in an unacceptable cosmetic outcome. A number of women elect to have a mastectomy, most commonly because radiotherapy can often be avoided after total removal of the breast. All women who have mastectomy are offered breast reconstruction by one of our plastic surgeons.

Draining Lymph Nodes

Invasive breast cancer will spread to the lymph glands in 40% of cases. It is therefore very important to know if this has happened in order to plan optimal further management such as chemotherapy or hormonal therapy.

The removal of these nodes is called axillary dissection. If breast-conserving surgery is chosen, a separate incision is required. If, however, mastectomy is the operation of choice, the nodes can be removed via the same surgical incision.

The removal of the axillary nodes may lead to shoulder stiffness and restriction of movement, numbness down the inside of the upper arm and in 10 – 15% of cases, it may result in long term swelling of the arm know as lymphoedema.

As only 40% of breast cancers spread to the axillary nodes, 60% of patients will not benefit from this surgery. If the cancer has spread, it will have done so in an orderly fashion by lodging in one node first and then perhaps spreading into other nodes. The first node where the cancer cells spread to is known as the sentinel node.

We now know how to locate the sentinel node by the use of special pre-operative tests and high-tech intraoperative visualization. If the sentinel node does not contain any cancer cells, the removal of the rest of the axillary nodes may not be necessary and therefore the side effects of the surgery will be minimised. If the sentinel node does harbour cancer cells, the remainder of the nodes will need to be removed.

This technique is called sentinel node biopsy and your surgeon will discuss this technique with you at the time of your consultation to plan your surgery.

If you have a question, e-mail us at: breastsurgery@tsbc.com.au