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