A Young Woman’s Guide To Breast Surgery

I need some treatment – what’s going to happen?

Depending on your diagnosis, you may be offered some kind of treatment. There are other resources online where you can find out about breast cancer treatments like radiotherapy, chemotherapy and hormone therapy so I’m going to focus on the surgery aspect here. If you have a solid lump, it will probably need to be removed surgically so here are the most common operations:

Laser surgery
In some hospitals and under certain private healthcare schemes, you may be offered laser surgery. This is where a laser beam penetrates the breast tissue and breaks up the lump underneath – it is generally only recommended for benign fibroadenomas. The procedure is normally carried out under a local anaesthetic as a day case.

Two needles are placed into the breast with fibre optic strands – these needles channel the beams via the fibre optics into the tumour itself while you are lying down. It can feel a bit strange lying on there awake during the procedure but you won’t see anything gory! Sometimes mild sedation can be used as well and you will probably be splashed with cold water during the procedure to prevent burning. This technique does not always work so it is worth considering alternative options.

If you have a fibroadenoma, and with some forms of self-contained breast cancer, a lumpectomy will be recommended. This is where the lump or tumour itself is removed through a surgical incision under a general anaesthetic. You will be left with a scar on your breast and usually soluble stitches will be used – you may also be given some painkillers while the wound is healing. This is normally carried out either in day surgery or as an overnight case. The lump will be sent off for analysis just to make sure and you will probably be allocated a follow-up outpatient appointment with the consultant.

Wide local excision
If you have a phyllodes tumour or a malignant tumour, you will be recommended for a wide local excision. This is where the tumour and some of the surrounding tissue is removed to obtain what’s called “clear margins”. This is very important to reduce the chances of the tumour from returning but depending on the size of the tumour, it can leave a dent in the breast. This procedure is carried out under a general anaesthetic, often leaves a larger scar than a lumpectomy and you may be given painkillers afterwards.

If you have a lot of tumours, calcifications, a genetic history of breast cancer or have had multiple operations, you may be offered a mastectomy. This is the removal of your breast tissue and, in some cases, nipples and lymph nodes. Your consultant will discuss whether it is safe to keep your nipples and this varies from case-to-case. A new technique labelled “keyhole mastectomy” is currently being trialled in the UK but is not yet available for clinical use.

You may be offered a breast reconstruction as well – this can often be done at the same time as the mastectomy so you wake up with breasts. In some instances, it may not be possible to do this but your consultant will be able to discuss this with you. If you decide not to have a reconstruction or if an immediate reconstruction is not an option, you can use what’s called prostheses. These are breast-shaped forms either made from fabric (also known as a “softie”) or a silicon-based material. You can buy specially-designed mastectomy bras and swimwear which have built-in pockets to keep your prostheses firmly in place or you may prefer to attach them to your breast using a specially-designed self-adhesive tape. These prostheses are also very useful if you have dents in your breast from wide local excisions.

If you have a mastectomy or a wide local excision, you may also be offered a reconstruction. This is where the breast or breasts are rebuilt. This can be done either using your own tissue (common sites include the back, tummy or bottom) or with a silicone or saline implant. It can sometimes be carried out in the same operation and always under a general anaesthetic.

Your reconstruction choices will depend on whether you need further treatment (eg chemotherapy or radiotherapy), your build and the kind of lifestyle you lead. Some women may find implant only reconstructions are better for them while others will prefer the more natural look of a tissue reconstruction. Your surgeon will be able to discuss your needs and what you want to achieve. Nipples can be reconstructed using skin flaps, which can then be tattooed a “nipple colour”.

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