Partial mastectomy

Up until the 1970s all breast cancers were treated by mastectomy. It has now been shown that in many cases more limited surgery can provide equally good results. This breast conserving surgery involves removal of a segment of the breast (partial mastectomy) followed by a course of radiotherapy to the remaining breast tissue.

Surgery is performed through a curved incision in the breast that can often be placed around the nipple or in the crease under the breast where scarring is quite minimal.

The aim is to remove the cancer together with a margin of healthy tissue. The pathologist may be called into theatre during the operation to have a preliminary look at the excised tissue and alert us to any close margins. This is called a frozen section examination. Additional tissue can then be removed to ensure good clearance of the cancer. Depending on your breast size, you may lose up to 20-30% of the breast tissue. The nipple position may also change. Remaining tissue is brought together to recreate the shape of the breast. There are a variety of techniques available to move new tissue into the gap created by removing the cancer and these can make a big difference to the final cosmetic result. A small external breast prosthesis can be worn in the bra to compensate for minor differences in size. Alternatively one can consider having a reduction procedure to adjust the size of the other breast.

The cosmetic result after conservative surgery depends on a number of factors:

• Breast size
• Size and location of cancer
• Margin of excision

Effect of radiotherapy - radiotherapy administered after surgery can cause shrinkage of the breast and it is difficult to predict how significant this will be.

There are two important things to understand about breast conserving surgery:

1. The possibility of a second operation. We try to determine the extent of the cancer as accurately as possible before surgery using clinical and ultrasound examination of both breasts plus mammography. MRI scanning may be useful in some situations to identify multi-focal or bilateral disease. In about 10% of cases the cancer turns out to be more extensive than expected and it will be necessary to go back to theatre for a wider excision or even a full mastectomy a few days later.

2. The need for radiotherapy. Breast conserving surgery requires a course of radiotherapy following the operation. Without radiotherapy the risk of local recurrence is unacceptably high. (30-40%) Radiotherapy reduces this to about 10%.

Is breast conserving surgery safe?

There is a slight increase in the risk of local recurrence of the cancer when compared with mastectomy (8 - 15% vs. 5 - 10 %) but local recurrence can usually be treated and survival is the same with both operations.

What to expect after surgery.

Both partial and full mastectomy operations are performed under a general anaesthetic and require about two to two and a half hours in theatre. A plastic suction drain may be inserted to drain any fluid that may build-up in the first few days after surgery. The drain is usually removed after 2-3 days, before you leave hospital. The incisions are closed with dissolving sutures positioned under the skin and this means that no stitches need to be removed. You will spend 2-3 nights in hospital and by the time you are discharged you should be quite mobile and able to manage all routine activities. Pain is usually easily controlled with Panadol or other simple pain tablets. There will be a waterproof, plastic dressing covering the wound and you can bath and shower as normal

Possible complications after partial mastectomy

Bruising - is common and will settle in a couple of weeks.

Bleeding - occasionally there may be extensive bleeding into the tissues that can cause painful swelling. This is called a haematoma and you may need to go back to theatre so that the bleeding can be controlled properly..

Wound infection - causes the wound to become tender, warm and swollen. There may be redness and discharge of pus from the wound. You may feel feverish. Antibiotics will be required.

Seroma - A collection of fluid may form at the site of surgery. This can be easily drained in the clinic with a needle and syringe. Fluid build-up usually stops within 3- 4 weeks.

Decreased sensation - There may be areas of numbness in the skin of the breast and also along the inside of your arm.

Swelling and heaviness - the breast and chest wall may feel heavy and uncomfortable for some months after radiotherapy or surgery. Using a comfortable and supportive bra during this time will help.

Breast and nipple distortion - After partial mastectomy there may be a significant change in the shape and size of the breast. The nipple position may also change. A small breast prosthesis can be worn in the bra to compensate. Alternatively one can consider having a reduction procedure to adjust the size of the other breast.

Local recurrence - there is a 5-10% chance that the cancer could recur

Emotional and psychological effects - the diagnosis and treatment of breast cancer can have significant effects on a womens' self-esteem, body image and relationships. Please discuss any concerns or difficulties in this area. Support and professional counselling are available.