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How Does Breast Cancer Surgery Work

Choosing To Go Flat After A Mastectomy

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You might decide that you dont want to wear a prosthesis or have a breast reconstruction after having a mastectomy. You may choose to be flat.

Women decide to do this for various reasons. It might be because you:

  • dont want to have more surgery
  • want to get back to everyday life as soon as possible
  • dont want to wear prosthesis, or find them uncomfortable

Your surgeon and breast care nurse will talk to you about all your options. They will explain the pros and cons to help you make the right decision for you. You may need time to make your decision. Talking to family and friends about how you feel can help.

A charity called Flat Friends supports ladies living without reconstruction after a mastectomy.

Taking Anastrozole With Other Drugs

If youre taking any other prescribed or over-the-counter medicines, check with your treatment team or pharmacist if you can take these with anastrozole.

Do not take other drugs containing oestrogen, such as hormone replacement therapy , while youre taking anastrozole as this may interfere with its effectiveness.

Talk to your specialist, pharmacist or GP about any complementary therapies, herbal remedies or supplements you want to use before you start using them.

Complementary And Alternative Medicine

Complementary and alternative medicine are medicines and health practices that are not standard cancer treatments. Complementary medicine is used in addition to standard treatments, and alternative medicine is used instead of standard treatments. Meditation, yoga, and supplements like vitamins and herbs are some examples.

Many kinds of complementary and alternative medicine have not been tested scientifically and may not be safe. Talk to your doctor about the risks and benefits before you start any kind of complementary or alternative medicine.

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Why Are People Offered Chemotherapy

Chemotherapy is given to reduce the risk of breast cancer coming back in the future. It uses anti-cancer drugs to destroy cancer cells.

It is most commonly given after surgery.

Some people wonder why they need chemotherapy if theyve already had surgery to remove their cancer. Whether someone is offered chemotherapy depends on a number of features of their cancer. These include the size and grade of the cancer whether it has spread to any of the lymph nodes under the arm and whether the cancer is hormone receptor and HER2 positive or negative.

For some people the benefit is clear, but for others its less certain. This is why cancer specialists may use a test, like the one described above, to help estimate the benefit.

Because it affects cells throughout the body, chemotherapy can cause side effects including sickness, hair loss and an increased risk of infection.

Enhancing Healthcare Team Outcomes

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Breast cancer involves an interprofessional team to achieve the best possible outcomes. This team includes oncologic and plastic surgeons, medical oncology, radiation oncology, pathology, radiology, nurse navigators, and multiple other individuals to discuss each patient and formulate a treatment plan. Oncology specialty nursing staff will assist during procedures, provide post-procedural followup care, and administer medication and answer patient questions. These nurses must keep the clinician staff up to speed on all developments for the patient’s progress or lack thereof. In cases where chemotherapy will be an adjunct, a board-certified oncology pharmacist should work with the oncology team to select the appropriate agents, verify dosing, and counsel the patient on adverse effects, also reporting any concerns to the team. The outcomes for patients with breast cancer continue to improve with the increased use of interprofessional teams, as demonstrated in multiple retrospective studies.

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What Is Radioactive Seed Localization

Radioactive seed localization is a technique used to locate and remove small breast cancers that are detected on a mammogram or ultrasound but cannot be felt by your surgeon during a breast exam.

The procedure can take place up to a week before your lumpectomy. A radiologist places a tiny radioactive seed, about the size of a grain of rice, in your breast to mark the exact location of the cancer. The implanted seed contains a small amount of radiation, which helps your surgeon find the cancer at the time of your surgery using a handheld radiation-detection device.

The seed is removed by your surgeon during your lumpectomy.

Seeking Support For A Breast Cancer Diagnosis

If youve been diagnosed with breast cancer, its a great idea to talk to a therapist. A therapist can help you cope throughout your breast cancer journey.

The APA recommends a combination of group therapy, which allows women to share emotional support, and individual therapy, which helps women learn problem-solving skills and alter patterns of negative thinking. A therapist can also help you work through body image or sexuality issues related to a mastectomy or treatment in general.

While breast cancer and mental illness may both feel like insurmountably large problems, you can take simple steps every day to feel better. Staying as active as you can, focusing on healthy eating including lots of fruits and vegetables, and reaching out to friends, family, a support group, or a faith group can all help, says the CDC.

You also dont have to be a medical professional to give support to people in your life with breast cancer. Social support matters, too. Research shows that having supportive intimate partners and family members increases breast cancer survivors overall wellbeing.

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Arm Care After Lymph Node Removal

Removing lymph nodes during BCS may affect how lymphatic fluid drains from your arm. Problems with lymphatic drainage can cause swelling in your arm. You may also be at greater risk for infection from injury to your arm. And there is a higher risk for blood clots in your armpit veins after surgery to the area.

You will have to follow certain safety steps for the rest of your life after lymph node removal. This will help prevent problems in the affected arm. These safety steps include:

  • No needle sticks or IVs placed in the affected arm

  • No blood pressure measurements in the affected arm

  • Follow instructions about arm exercises carefully

  • Avoid injuries, such as scratches or splinters, to the affected arm

  • Raise the arm, with your hand above your elbow, to help drain lymphatic fluid

  • Wear gloves when gardening or doing any activity where there is a risk for getting a cut on your fingers or hands. Also wear gloves when using strong or harsh chemicals, such as detergents or household cleaners.

  • Avoid sunburns

  • Use a clean razor to shave under your arm

  • Avoid wearing any tight items on the affected arm. This includes elastic cuffs, tight watches, or other jewelry.

  • Use your good arm or both arms to carry heavy packages, bags, or purses

  • Avoid insect bites or stings by using insect repellents or wearing long sleeves

Your doctor may give you other instructions, depending on your situation.

Which Operation Should I Have

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Some people will be offered a choice between breast-conserving surgery and a mastectomy.

Long-term survival is the same for breast-conserving surgery followed by radiotherapy as for mastectomy.

Studies show that women who have a wide local excision may be slightly more likely to have a local recurrence , which can be treated again. However, most people dont have a recurrence.

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How To Care For Surgical Drains

When you wake up from surgery, your recovery room nurse will probably warn you that you need to be careful with your drains. Depending on the length of the tubes , it’s easy to get these tangled up with IV lines, your bedclothes, and anything else nearby.

Your nurse will periodically drain your bulbs and show you how it’s done. He or she will log the amount of drainage from each tube, and you will be instructed to continue the log on your own until your drains are removed.

Before you leave the hospital, your healthcare team will review drain management, tell you about symptoms that should prompt you to call, and schedule a follow-up visit to have them removed.

Surgery To Stop The Ovaries From Working

This is also a type of ovarian ablation. You might choose to have an operation to remove your ovaries instead of having drug treatment to stop them working. You have this operation as keyhole surgery. It is called laparoscopic oophorectomy and you have it under general anaesthetic . You usually stay in hospital overnight.

The surgeon makes a number of small cuts into your tummy . They put a long bendy tube called a laparoscope into one of the cuts. The laparoscope connects to a video screen.

The surgeon puts small instruments through the other cuts to carry out the operation and remove the ovaries. They close the cuts with stitches and cover them with small dressings.

Removing your ovaries causes you to have a sudden menopause. The symptoms include hot flushes, sweating and mood swings.

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Will The Nhs Fund An Unlicensed Medicine

It’s possible for your doctor to prescribe a medicine outside the uses it’s licensed for if they’re willing to take personal responsibility for this ‘off-licence’ use of treatment.

Your local clinical commissioning group may need to be involved, as it would have to decide whether to support your doctor’s decision and pay for the medicine from NHS budgets.

Page last reviewed: 28 October 2019 Next review due: 28 October 2022

When Is Lumpectomy Not An Option

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Your healthcare provider may not recommend a lumpectomy for several reasons. If you have multiple tumors in one breast or have a large cancer, you may not be a candidate for this procedure.

For most people, radiation therapy follows a lumpectomy. If your provider recommends you not receive radiation therapy or you do not want radiation, a lumpectomy may not be right for you. Providers may want you to avoid radiation if you received radiation therapy for previous breast cancer in the same breast or are currently pregnant.

Your provider may also advise against a lumpectomy and radiation if you have:

  • A genetic mutation that increases your odds of having breast cancer again.
  • Lupus or another medical condition that raises your risk of radiation therapy side effects.

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Preparing For External Beam Radiation Therapy

Before your treatment starts, the radiation team will carefully figure out the correct angles for aiming the radiation beams and the proper dose of radiation. They will make some ink marks or small tattoos on your skin to focus the radiation on the right area. Ask your health care team if the marks they use will be permanent.

External radiation therapy is much like getting an x-ray, but the radiation is stronger. The procedure itself is painless. Each treatment lasts only a few minutes, but the setup timegetting you into place for treatmentusually takes longer.

Who It Is Suitable For

Anastrozole is suitable for women who have been through the menopause and whose breast cancer is oestrogen receptor positive.

Sometimes anastrozole is given alongside a drug called goserelin to women who havent yet been through the menopause.

If your cancer is hormone receptor negative, then anastrozole will not be of any benefit.

Anastrozole may be given to reduce the risk of breast cancer in women who havent had breast cancer but have an increased risk of developing it because of their family history.

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Why Is A Lumpectomy Performed

Your doctor may recommend a lumpectomy to treat breast cancer or to remove a benign tumor of the breast . Your doctor may only consider a lumpectomy if other treatment options that involve less risk of complications have been ineffective. Ask your doctor about all of your treatment options and consider getting a second opinion before deciding on a lumpectomy.

Who Needs A Lumpectomy

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You may be a candidate for a lumpectomy if:

  • Cancer only affects one area of your breast.
  • A tumor is relatively small compared to your breast size
  • Your provider is confident you will have enough remaining tissue to reshape your breast after removing the tumor.
  • You are able to complete radiation therapy.

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How Is Chemotherapy Given

Chemo drugs for breast cancer are typically given into a vein , either as an injection over a few minutes or as an infusion over a longer period of time. This can be done in a doctors office, infusion center, or in a hospital setting.

Often, a slightly larger and sturdier IV is required in the vein system to administer chemo. These are known as central venous catheters , central venous access devices , or central lines. They are used to put medicines, blood products, nutrients, or fluids right into your blood. They can also be used to take out blood for testing.

There are many different kinds of CVCs. The most common types are the port and the PICC line. For breast cancer patients, the central line is typically placed on the side opposite of the underarm that had lymph nodes removed for the breast cancer surgery.

Chemo is given in cycles, followed by a rest period to give you time to recover from the effects of the drugs. Cycles are most often 2 or 3 weeks long. The schedule varies depending on the drugs used. For example, with some drugs, the chemo is given only on the first day of the cycle. With others, it is given for a few days in a row, or once a week. Then, at the end of the cycle, the chemo schedule repeats to start the next cycle.

Adjuvant and neoadjuvant chemo is often given for a total of 3 to 6 months, depending on the drugs used. The length of treatment for advanced breast cancer depends on how well it is working and what side effects you have.

What To Expect On The Day

You will usually be admitted to the hospital on the morning of your operation or occasionally the day before. Theres a brief explanation below of what will happen on the day of your surgery for more detailed information, see our booklet Your operation and recovery.

A doctor from the surgical team will talk to you about your operation and discuss what has been planned. If youve not already signed a consent form, youll be asked for your written consent. This confirms that you understand the benefits and risks of your surgery, and what you are agreeing to. If youre unsure, dont be afraid to ask the doctor to explain further.

Your anaesthetist will also usually visit you on the ward before your surgery. If youre feeling anxious and would like some medication to relax you before the operation, you can ask the anaesthetist.

Once all the pre-surgery checks have been done, youll be taken to the anaesthetic room where the theatre staff will confirm your name, any allergies and when you last ate and drank. Youll be given a combination of drugs into a vein .

Youll usually be asked to take deep breaths and as the anaesthetic takes effect you will fall into a deep sleep. Once you are fully anaesthetised you will be taken into the theatre.

For more information about going into hospital, see our booklet Your operation and recovery.

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How Much Surgery Costs

The cost of surgery depends on many factors, including:

  • The type of surgery you have
  • How many specialists are involved in your surgery
  • If you need local, regional, or general anesthesia
  • Where you have surgeryat an outpatient clinic, a doctors office, or the hospital
  • If you need to stay in the hospital, and for how long
  • The part of the country where you live

Talk with your health insurance company about what services it will pay for. Most insurance plans pay for surgery to treat cancer. To learn more, talk with the business office of the clinic or hospital where you go for treatment. If you need financial assistance, there are organizations that may be able to help. To find such organizations, go to the NCI database, Organizations that Offer Support Services and search for “financial assistance.” Or call toll-free 1-800-4-CANCER to ask for information on organizations that may help.

Stopping The Ovaries Working

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In premenopausal women, doctors might use a type of hormone treatment to stop the ovaries from producing oestrogen. This type of drug is called a luteinising hormone releasing hormone . For example, goserelin and leuprorelin . You might have this on its own or with other hormone therapy drugs.

LHRH drugs work by blocking a hormone made in the pituitary gland that stimulates your ovaries to make and release oestrogen. This stops your ovaries from working. So you won’t have periods or release eggs while you are having the injections.

When you stop taking the drug, your ovaries should start working again. But, if you’re close to the age at which your menopause would naturally start, your periods might not start again.

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What Happens During Lumpectomy Surgery

The lumpectomy surgery itself should take about 15-40 minutes.

Your surgeon will probably operate with a kind of electric scalpel that uses heat to minimize bleeding . Most surgeons use curved incisions that follow the natural curve of your breast and allow for better healing. If the tumor can be seen or felt, the surgeon will remove it along with a rim of healthy tissue around it.

Sometimes, but not always, a rubber tube called a drain will be surgically inserted into your breast area or armpit to collect excess fluid that can accumulate in the space where the tumor was. The drain is connected to a plastic bulb that creates suction to help remove fluid. Finally, your surgeon will stitch the incision closed and dress the wound.

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