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Breast Conservation Surgery

Breast conservation surgery aims to remove a cancer from the breast with a wide margin whilst maintaining the shape and appearance of the breast as much as possible.

A wide variety of surgical techniques and scar placements are possible to try and best achieve these aims. To be suitable for this operation the cancer needs to be small enough relative to the size of the breast to allow a wide margin of normal tissue to be excised around the cancer.

Whilst you are asleep under anaesthetic, an X-ray is taken of the tissue removed to try and ensure that a good margin has been achieved.

However, this margin of tissue has to be normal under the microscope and the results from looking at this tissue under the microscope are not available until 1 – 3 weeks later.

If the margin is clear under the microscope, radiotherapy is given to the rest of the breast tissue on that side. If the margins are not clear (20-25% of cases), the options are either to go back and remove a bit more tissue or perform a mastectomy.

Sometimes, combining wide local excision with a breast reduction or breast lift can make it possible to remove a large cancer without distorting the breast shape (therapeutic mammoplasty). Such procedures can allow a wider excision of the cancer with a greater chance of complete removal at the first operation. Therapeutic mammoplasty can even make the appearance of the breast after surgery better in some cases.

Occasionally, it may be an option to replace tissue removed from the breast during wide local excision with tissue from the back or the side of the chest.These operations are called mini LD flap and perforator flaps respectively.

What Are The Admission and Aftercare Requirements For Breast Conservation Surgery?

You are generally admitted on the day of surgery, occasionally the day before.

You will be re-examined and the site of the scar drawn on the breast. If your cancer was detected by mammography and cannot be felt then the radiologists will give an injection of a tiny bit of radiation in the breast or place a wire so that the correct area can be identified and removed at surgery.

The operation takes about 40 minutes to one and a half hours depending on the extent of surgery required. Dissolvable stitches are used and a waterproof dressing of special glue is applied.

This dressing can be left alone and the glue flakes off after 2 or 3 weeks. Sometimes a support dressing is used for 24 hours and you may be advised to wear a supportive bra day and night for a couple of weeks.

A day case operation is possible for many women; some prefer or are recommended to stay overnight.

This often depends upon the type of surgery that is performed under the arm (axilla), as well as your general fitness and the degree to which you can be looked after at home.

How Long Does Recovery Take After Breast Conservation Surgery?

Wide local excision is an operation that is not associated with a lot of pain. Most of the discomfort after the operation is related to the surgery performed to remove nodes under the arm, in the axilla, which usually settles after a few days.

Most women are able to perform normal activities within a few days of this operation. Overall recovery and return to work will depend upon a variety of factors including the extent of surgery and what after-treatment is necessary.

Appearance Of The Breast After Breast Conservation Surgery (Wide Local Excision And Radiotherapy)

Because the operation involves removing tissue from the breast, the affected breast may appear slightly smaller after surgery.

The overall cosmetic appearance of the breast after surgery (and radiotherapy) is something that some women attach more importance to than others, but it is usually possible to achieve a very good cosmetic result in most women especially if they have small breast tumours, with minimal scarring, relatively straightforward surgery and a discreet indentation to the breast.

There are many surgical tricks that can be used to minimise the deformity caused by surgery, some of them involving additional scarring and/or additional surgery, but many of them very simple.

Some surgical techniques can also minimise the adverse effects of radiotherapy. Often, an indentation or a slight breast deformity develops after radiotherapy.

Radiotherapy is one of the “unknowns” in terms of cosmetic results from wide local excision. It never enhances cosmesis and whilst some women have no lasting effects of radiotherapy, others (unpredictably) have obvious signs that radiotherapy has been given.

Therapeutic Mammoplasty is a newly adopted technique for breast conservation cancer surgery. As it can combine a tumour wide local excision (lumpectomy) with a breast reduction, it allows larger tumour excisions than standard surgery and produces a smaller breast with a good shape. It is an option in patients who are large breasted and who wish to be smaller, and can avoid mastectomy in many cases.

It also minimises the effect of radiotherapy on the breast by reducing deformity and indentation. Mr Sheikh Ahmad was one of the original surgeons to popularise this technique, which now is widely accepted as the standard of care in many institutions.

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