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The London Breast Clinic
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Breast Surgery

You will always know what operation you will be having before being admitted to hospital. All our patient care is based on informed consent and you will not be asked to consent to further or alternative measures.

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Breast Surgery

You will always know what operation you will be having before being admitted to hospital. All our patient care is based on informed consent and you will not be asked to consent to further or alternative measures.

Different surgical procedures are briefly explained here.

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Breast Excision Biopsy

An operation in which abnormal breast tissue or a lump is removed (excised) through the smallest and most appropriate incision, a small amout of surrounding tissue (margins) may also be taken to ensure full clearance. These are analysed at the time of surgery by frozen section for preliminary pathology with the pathology confirmed by paraffin section.

Stereotactic or Guidewire Excision Biopsy

This type of excision biopsy is indicated when patients have an abnormality that is visible on a mammogram or ultrasound but cannot be felt in clinical examination. To assist the surgeon, the site of the abnormality to be biopsied is marked by a consultant radiologist, with a guide-wire or skin marking (localisation), using either mammography or ultrasound.

Frozen Section

The tissue excised undergoes instant preliminary analysis in the operating theatre by a histopathologist. The tissue examined can include the section which appeared abnormal and the margins or surrounding area. The specimen will subsequently receive more detailed analysis in a laboratory.

Axillary Dissection

Lymph nodes or glands are removed through the axilla or armpit, to ascertain whether the cancer has spread to the lymph glands. This is usually undertaken at the same time as surgery to remove a tumour. If the cancer is near the axilla a single incision can be used. During a mastectomy, the gland will be removed through the mastectomy incision. The lymph nodes removed will be analysed by a histopathologist.

Sentinel Node Biopsy

This technique has been the subject of a number of clinical trials around the world. It is used to identify whether cancer has spread to the lymph nodes. It involves injecting a small amount of radioactive material and a dye, which identifies the sentinel node, this is the first node to receive lymph fluid from a tumour. If the sentinel node is clear, it usually means that the other nodes are clear and removal of further lymph nodes under the arm may not be necessary.

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Operations to Remove Tumours

Wide Local Excision

The lump, or tumour, is removed, with a small amount of surrounding tissue (the margins.) These are analysed at the time of surgery by frozen section. (See above)

Segmental Mastectomy (quadrantectomy)

A segment of the breast containing the tumour is removed. The location and amount of the segment removed depends on the site and size of the underlying cancer.

Total Mastectomy

In this operation the breast is removed completely. There are several reasons why a total mastectomy may be needed. The cancer may be multi-centric, that means it occurs simultaneously in several different areas of the breast, or there may be a large single cancer in the middle of the breast. The consultant will always explain the reasons for the operation recommended.

At operation a very small vacuum tube drain, 2mm in diameter, is usually inserted in order to prevent undue bruising.

In order to obtain the best possible cosmetic result the skin wound is closed in three layers. The deep breast tissue is closed with soluble stitches, which are gradually absorbed by the body. Some thickening may occur under the scar for a few months, while this process occurs and the wound settles. The closure is completed by a single subcuticular suture with steristrips holding the skin edges together.

Breast Reconstruction

This is carried out to restore the shape of the breast following mastectomy. There are a number of different techniques used to achieve the reconstruction. These will be explained and discussed with the patient as part of the treatment process by both the consultant breast surgeon and also with the consultant plastic surgeon. It may be undertaken immediately after the mastectomy by the surgeon who carried out the procedure (a onco-plastic surgeon), or by a plastic surgeon working with the consultant breast surgeon. Alternatively it may be carried out at a later date. If this is planned provision will be made for the subsequent procedure at the time of the mastectomy. Patients, who choose not to have reconstructive surgery, will be advised about prostheses (false breasts).

Drainage and Wound Closure

At operation a very small vacuum tube drain, 2mm in diameter, is usually inserted in order to prevent undue bruising.

In order to obtain the best possible cosmetic result the skin wound is closed in three layers. The deep breast tissue is closed with soluble stitches, which are gradually absorbed by the body. Some thickening may occur under the scar for a few months, while this process occurs and the wound settles. The closure is completed by a single subcuticular suture with steristrips holding the skin edges together.

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Post Operative Treatment

Radiotherapy, Chemotherapy and Hormone therapy

A patient sometimes needs further treatment following surgery for cancer. This is decided when the results of specimens taken at the operation have been fully analysed. There are several types of treatment available, all of which will be discussed with the patient when they consult the radiologist and/or oncologist. The treatment chosen will be the most appropriate to reduce, as much as possible, the chances of any further problems.

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