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Nicola Davis - Breast & General Surgeon
Private Service, General Surgery, Breast
Breast Disorders Including Oncoplastic Breast Cancer Surgery
General surgery covers breast diseases including breast cancer and benign breast conditions such as benign breast lumps and nipple discharge. It also covers assessment and management of people who have a strong family history of breast cancer or who are known to carry a breast cancer causing gene.
You will usually require a number of investigations including a mammogram, ultrasound scan and biopsy of tissue for a diagnosis to be made, these are usually done by a Radiologist prior to your surgical appointment.
Breast cancer surgery may be:
- Simple or Total Mastectomy: all breast tissue, skin and the nipple are surgically removed but the muscles lying under the breast and the lymph nodes are left in place.
- Modified Radical Mastectomy: all breast tissue, skin and the nipple as well as some lymph tissue are surgically removed.
- Skin or Nipple Sparing Mastectomy: the underlying breast tissue is removed, leaving the skin envelope and often the nipple/areola in place. This is used in patients who are having an immediate breast reconstruction.
- Lumpectomy/Wide Local Excision: the breast lump and surrounding tissue, as well as some lymph tissue, are surgically removed. When combined with radiation treatment, this is known as breast-conserving surgery.
- Sentinel Node Biopsy: involves removing the first draining nodes of the breast and is important in treatment and staging of early breast cancer.
- Axillary Lymph Node Dissection: involves removing all of the draining lymph nodes of the breast in patients who are known to have spread of breast cancer to these nodes.
Breast Reconstruction
When a breast has been removed (mastectomy) because of cancer or other disease, it is possible in most cases to reconstruct a breast similar to a natural breast. A breast reconstruction can be performed as part of the breast removal operation or can be performed months or years later.
There are two methods of breast reconstruction: one involves using an implant; the other uses tissue taken from another part of your body. There may be medical reasons why one of these methods is more suitable for you or, in other cases, you may be given a choice.
Implants
A silicone sack filled with either silicone gel or saline (salt water) is inserted underneath the chest muscle or skin. Before being inserted, the skin will sometimes need to be stretched to the required breast size. This is done by placing an empty bag where the implant will finally go, and gradually filling it with saline over weeks or months. The bag is then replaced by the implant in an operation that will probably take 2-3 hours under general anaesthesia (you will sleep through it). You will probably stay in hospital for 2-3 days.
Flap Reconstruction
A skin flap taken from another part of the body such as your stomach or back, is used to reconstruct the breast. This is a more complicated operation than having an implant and may last up to 6 hours and require a 5- to 7-day stay in hospital. If you require a flap reconstruction, a Plastic Surgeon will perform this part of the procedure.
Read more about breast operations here.
