Barnaby Smith – General, Laparoscopic and Endoscopic Surgeon
Breast Disorders Including Breast Cancer
General surgery covers breast diseases including breast cancer. These conditions are often initially dealt with in a specialised breast clinic which is able to perform a number of investigations (e.g. mammography, ultrasound, needle biopsy) during the initial outpatient clinic visit.
Breast Cancer Surgery
This may be:
- Simple or Total: all breast tissue, skin and the nipple are surgically removed but the muscles lying under the breast and the lymph nodes are left in place.
- Modified Radical: all breast tissue, skin and the nipple as well as some lymph tissue are surgically removed.
- Partial: the breast lump and a portion of other breast tissue (up to one quarter of the breast) as well as lymph tissue are surgically removed.
- Lumpectomy: the breast lump and surrounding tissue, as well as some lymph tissue, are surgically removed. When combined with radiation treatment, this is known as breast-conserving surgery.
When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later.
There are two methods of breast reconstruction: one involves using an implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice.
A silicone sack filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle and skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will probably take 2-3 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 2-5 days.
A skin flap taken from another part of the body such as your back, stomach or buttocks, is used to reconstruct the breast. This is a more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital.