Although breast cancer and the subsequent excision or removal of the tumor do not fall into the purview of plastic surgery until afterwards when reconstruction is needed, I wanted to discuss some of these procedures for 2 reasons. The first being the prevalence of breast cancer and how it effects almost everyone, if not directly it does so indirectly by developing in 1 out of 8 women. This brings me to the second reason, which is that this disease has been diagnosed and is in the process of being treated in women that are very dear to me. This is what has brought me to Greece today and what has led me to write this article.
When a patient is diagnosed with breast cancer the first thing that comes to mind are the images of radical mastectomy which was the mainstay of breast cancer treatment until the 1970’s. Thousands and probably millions of women’s lives have been saved by this drastic and life altering procedure developed by Drs Halsted and Meyer in 1894.
Today surgeons have other, less invasive options available for their patients which are collectively known as breast – conserving or breast – preserving. Today’s topic of discussion is the lumpectomy.
Lumpectomy is the removal of the breast tumour, or lump, plus some of the normal tissue that surrounds it. This is done to make certain that all of the cancer cells are removed from the patient because even leaving one cell in is a danger of regrowth.
This procedure is, for all intensive purposes, a partial mastectomy due to the removal of part of the breast tissue. Yet the amount of tissue is very small, sparing the rest of the actual breast. Of course the amount of tissue removed depends on the size, shape, and spread of the tumour. Most of the time the resection of lymph nodes in the axilla are also required to either remove cancer cells or to stop the spread of cancer cells known as metastasis.
The procedure is performed under general anaesthesia, which means the patient is asleep the whole duration of the operation. A small incision is made over the location of the tumour and it with the surrounding healthy tissue is carefully removed. It is imperative that no cells are left inside and for this reason tools and blades that have come in contact with the tumour are constantly switched out to prevent seeding.
After the procedure is done and all of the cancerous tumour is excised, a drain is sometimes inserted if there is risk of haematoma development. This drain will be removed in 1 to 2 days post operatively depending on the amount of blood discharged in a 24 hour period.
The patient is able to sit, stand, and later walk only a few hours after the operation. This means that if the operation is performed in the morning, the patient will be able to be up and about by the late afternoon or evening. Of course analgesics will be prescribed and given at regular intervals to prevent and combat the natural pain that comes from this and any other invasive procedure, but most of the time it is easily controlled. The patient goes home after a hospital stay of only 1 to 2 days. The reason they are kept in at all is for close wound and pain monitoring to make sure everything is under control.
Skin sutures today are usually are dissolvable and there is no need for removal post operatively when the wound has healed. The surgical wound is monitored for approximately 10 to 14 days to make certain it remains healthy is healing according to plan. In these first few weeks it is important to wear a comfortable sports or support bra, during the day but also at night during sleep, in order to minimize movement and decrease possible pain.
Many patients may require subsequent radiation, chemo, hormonal therapy or some combination of them in an attempt to kill any remaining cancer cells. Radio therapy is prescribed if the cancer is in its’ early stages, 4 centimetres or smaller, located in one site, and removed with clear margins. The duration and the type of treatment depend on the staging of the cancer. After all treatment has been concluded, approximately 6 months to a year post lumpectomy, reconstruction can be done to repair the deficit or “dent” left by the removal of the cancerous and adjoining healthy tissue. The time allows for all healing the body will do on its’ own to take place, and for the full defect to be present. This permits the surgeon to accurately visualise and plan the proper reconstructive procedure necessary. Just as there many sizes and shapes of deficits, there are also different types of procedures available. For the straightforward lumpectomy the best procedure, and my personal preference, is lipofilling with fat harvested from the patient’s own fat pockets using the laser lipolysis technique. This we will leave for another day, since it is of special interest to me, and where my expertise comes into play.