Every patient with a diagnosis of breast cancer will receive an individualised treatment plan.
Therefore if you know someone else who has had breast cancer, the treatment you are offered may be different from the care they received. Usually treatment will consist of surgery, which may be a lumpectomy (also known as a wide local excision/breast conserving surgery) this removes the breast cancer and a margin of normal tissue around the outside of it. Or it might be recommended that you consider having a mastectomy (this removes all of the breast tissue on the side that has breast cancer). It is also likely that surgery to the armpit glands will be discussed.
Sometimes additional scans or biopsy tests are needed before the final surgical plan is made and you may be asked to come back to the clinic on a further occasion for the results of these. We are fortunate at MFT that our breast surgeons are able to offer a full range of surgical options for both breast conserving surgery and mastectomy with or without a reconstruction.
All of our breast surgeons will be able to discuss whether reconstruction is a suitable option with you and they can refer you to the Plastic Surgery team for some forms of reconstruction if needed. After surgery further treatments such as radiotherapy, chemotherapy and endocrine tablet treatment may be discussed. In some cases chemotherapy before surgery may be discussed (neo-adjuvant chemotherapy). The specific treatment options recommended will be individualised to your breast cancer.
Our breast surgeons perform a full range of breast conserving and mastectomy procedures, implant-based and pedicle flap immediate and delayed breast reconstructions. If a specialised “free flap” procedure is a surgical option you wish to pursue, they will refer you to one of the on-site Breast Plastic Surgeons for a further consultation and subsequent surgery if you wish to proceed.
The type of surgery you may need will depend on the kind of cancer you have, the size of the tumour and the size of your breasts. Our surgeons carry out three main types of surgery:
(also known as breast conserving surgery / wide local excision) – this is removal of just the cancer and an area of normal surrounding tissue, leaving the rest of your breast. This may not be recommended for you if you have a larger breast cancer, more than one cancer in the breast, or have had previous radiotherapy treatment in the same area.
(with or without a reconstruction) – to remove the whole breast, often including the nipple. This is recommended for larger cancers, when there are multiple cancers in the breast, if you have previously had radiotherapy to the area, or if it is your preference to have a mastectomy. This may be a simple mastectomy, where no reconstruction is performed and a prosthesis is worn in the bra to re-create a breast shape through clothes. It will also be discussed whether an immediate breast reconstruction at the time of the mastectomy is appropriate for you.
Lymph node surgery
If you have been diagnosed with an invasive breast cancer you will be offered lymph node surgery at the same time as your breast procedure. There are two main types of lymph node surgery:
- A sentinel node biopsy – This is the procedure that you will be offered if an ultrasound scan of your armpit glands is normal, or if you have needed a biopsy of your armpit glands and the biopsy has come back normal. This procedure involves having an injection of a liquid that is mildly radioactive beside the nipple of the breast that has the cancer.
- Axillary Clearance – If the ultrasound scan of your armpit glands show abnormal looking cells these will then be biopsied. If the biopsy then shows that the armpit glands have some cancer cells within them, you will be offered an axillary node clearance. This removes all the armpit glands. If this operation is needed your surgeon and breast care nurse will explain this procedure and its side effects to you in more detail.
The vast majority of our breast cancer surgery is performed as a day case. This means that as long as there is a responsible adult that is able to stay with you overnight on the day of your operation, you can often go home the same day as your surgery.
Macmillan and the physiotherapy team at the Nightingale Centre are working together to provide a new way of delivering rehabilitation after breast cancer. Please click on the link to take you to the yoursurgeryandrehab.co.uk website. Here you will find detailed information to help you before and after your operation, correct exercises advice, lymphoedema prevention, and details of the rehabilitation class you will attend.
In some cases, if an elderly patient has been diagnosed with breast cancer, has a lot of other medical problems and is not fit for surgery, anti-hormone tablet therapy alone may be discussed if the breast cancer is hormone sensitive (Oestrogen receptor (ER) positive). This treatment does not cure or get rid of the cancer, but can keep it under control. It is not a first –line treatment option and is only usually considered if surgery is not possible on medical grounds