Breast Cancer Surgeries

Breast Cancer Surgeries Women’s Clinic Wide Local Excision (Lumpectomy) What is a wide local excision?

It is a breast conserving surgery performed for early breast cancer of small size.

Why do I need it?

It is to remove early breast cancer while trying to leave a breast looking much the same as before surgery.

How is it done?

The cancerous part of the breast is removed together with a margin of normal breast tissue (1 cm).This is done under a general anesthesia.

Are there any risks?

In addition to the risks of anesthesia, there are small risks of bleeding, infection, breast asymmetry, scarring, or loss of sensation in the breast. Fluid may accumulate (also known as seroma) in areas where tissues have been removed.

Am I totally cured of cancer after the wide local excision?

Although the wide local excision removes almost all of the cancer cells, a few cancer cells may remain in the area. Radiation therapy is required to destroy any remaining cancer cells and is a must after this type of surgery.

Can I still continue to breastfeed?

Yes, you can still continue to breastfeed using the unaffected breast.

Breast conserving surgery (wide local excision or lumpectomy)

Mastectomy What is a simple mastectomy?

A simple mastectomy is the removal of the whole breast, some of the overlying skin and nipple.

• The woman does not want to have radiation therapy after wide local excision

What are the various kinds of mastectomy?

There are two kinds of mastectomies:

Are there any risks?

The risks of any surgery include infection, bleeding, adverse effects of general anaesthesia and reaction to medications. Risks specifically related to the mastectomy itself are numbness of the breast skin, partial tissue death of the breast skin and scarring. Fluid collections may occur.

Simple mastectomies • A simple mastectomy is the removal of the whole breast, some of the overlying skin and nipple Radial mastectomies • A radical mastectomy is the removal of the whole breast, some overlying skin, the nipple and all lymph nodes in the armpit Why do I need a mastectomy?

A mastectomy is required (as an alternative to Wide Local Excision) if: • Cancer is found in more than one area in the breast • The cancerous areas are large and little normal breast tissue remains • A wide local excision will result in an unacceptable cosmetic result

• It is the patient’s choice in breast cancer treatment

Am I totally cured of cancer after the mastectomy?

Mastectomy removes almost all breast tissue, however, if the tumour is large, or if lymph nodes in the armpit are involved, other treatment may be needed.

Are there any options available for cosmetic reasons after the mastectomy?

It is possible to opt for breast reconstruction surgery immediately or sometime after the mastectomy.

Approach your surgeon and inform him or her of your decision before your surgery.

Can I still breastfeed?

Yes, you can still continue to breastfeed using the unaffected breast.

Simple mastectomy

Sentinel Lymph Node Biopsy What is sentinel lymph node biopsy?

It is a procedure to determine if the cancer has spread to the lymph nodes in the armpit area. Only 20 to 25% of breast cancer patients have cancer that spreads to lymph nodes; majority do not have.

What is a sentinel lymph node?

A sentinel lymph node is the first lymph node which cancer is likely to spread from the primary tumour.

How is a sentinel lymph node biopsy performed?

This will be done under general anaesthesia.

A weak radioactive dye and a blue dye that stains the lymph nodes will be injected into the breast around the nipple. In the operating theatre, the surgeon will make an incision near your armpit to access the lymph nodes and will use a handheld probe to measure the areas which have the radioactive dye. The lymph nodes that have taken up the radioactive dye or are stained with the blue dye are removed. The lymph nodes are then sent to the pathologist who will examine the lymph nodes for any signs of cancer.

Is the procedure safe?

The procedure is very safe and only not recommended in a few conditions. Speak to your doctor to know if you are suitable.

What if there is cancer in the sentinel lymph node?

If cancer is found, another procedure called an axillary clearance is needed to remove all the nodes in the armpit.

Are there any side effects of the sentinel lymph node biopsy?

Side effects may include pain and bruising at the operation site, and also the rare possibility of an allergic reaction to the blue dye used to find the sentinel node. Patients may find that their urine is discoloured or that their skin in the area of injection has been stained the same colour as the dye. However, such effects are temporary.

Sentinel Lymph Node Biopsy

Axillary Clearance What is axillary clearance?

It is a procedure in which the majority of lymph glands, under the armpit draining the breast region is removed surgically,

through the same incision in mastectomy or another incision near the armpit if done with wide local excision.

Why is axillary clearance done?

Axillary clearance is done when there is evidence of malignant cells in a lymph node. This can be demonstrated on a prior sentinel lymph node biopsy or on a needle biopsy of an abnormal lymph node.

If the doctor can feel the lymph nodes on examination, axillary clearance will be advised.

What are the side effects commonly associated with axillary clearance?

A small number of patients may develop some pain, numbness of the armpit region and on the inner areas of the upper arm. A few patients (about 20%) may develop swelling of the arm and / or forearm (lymphedema). Some may develop a stiff shoulder. Fluid collection (seroma) may happen, necessitating drainage on occasions.

Yishun Health is a network of medical institutions and health facilities in the north of Singapore, under the National Healthcare Group.

Admiralty Medical Centre • (65) 6807 8000 • www.admiraltymedicalcentre.com.sg Khoo Teck Puat Hospital • (65) 6555 8000 • www.ktph.com.sg Yishun Community Hospital • (65) 6807 8800 • www.yishuncommunityhospital.com.sg The information is correct at the time of printing and subject to revision without further notice.

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