The breast is a glandular tissue (can secrete substances). Around the breast are lymph nodes. These are part of the lymphatic system.
Lymphatic vessels run from the limbs towards the heart, usually beside veins. They carry fluid called lymph, which is a collection of dead cells, waste material and leakage from ordinary blood vessels.
At various points along a lymphatic vessel lie lymph nodes. These are usually small – 5mm or less in most places. Lymph nodes are scattered at various points around the body, but the most important ones for breast disease are in the armpit.
Cancer cells travel along lymphatic vessels and collect in lymph nodes. In breast cancer, the lymph nodes of the armpit are usually the first site of spread.
It is important to understand that breast surgery for cancer is not cosmetic surgery. The appearance of the breast after surgery will be different from that before surgery.
The survival rates for women who have mastectomy (all of the breast removed) are the same as for women who have breast-conserving surgery accompanied by radiotherapy, and each form of treatment has its advantages.
Wide local excision
The removal of a lump in the breast and the tissue around it. The lymph nodes under the arm on the same side as the tumour may also be removed and tested for cancer. If the lump can not be felt, a marking wire may need to be placed before surgery. This is usually done in the X-Ray department using ultrasound or mammogram.
Partial or segmental mastectomy
The removal of the tumour as well as some of the breast tissue around it and the lining over the chest muscles below. Usually some of the lymph nodes under the arm are taken out and tested for possible spread of cancer.
Total or simple mastectomy
The removal of the whole breast. Sometimes lymph nodes under the arm are also taken out and tested for possible spread of cancer.
Modified radical mastectomy
The removal of the breast, many of the lymph nodes under the arm, the lining over the chest muscles, and sometimes part of the chest wall muscles.
The removal of the breast, chest muscles, and all of the lymph nodes under the arm. It is used only when the tumour has spread to the chest muscles and the wound may burst open.
Breast reconstruction involves the use of prostheses (artificial breast tissue) or tissue from other parts of the body. The type of prosthesis can be either silicone filled but are usually saline filled implants. Soft tissue may be taken from the other breast, the back or abdomen depending on body shape and size.
There are risks and complications with this procedure.
They include but are not limited to the following.
- Infection can occur, requiring antibiotics and further treatment.
- Bleeding could occur and may require a return to the operating room. Bleeding is more common if you have been taking blood-thinning drugs such as Warfarin, Asprin, Clopidogrel (Plavix or Iscover) or Dipyridamole (Persantin or Asasantin).
- Small areas of the lung can collapse, increasing the risk of chest infection. This may need antibiotics and physiotherapy.
- Increased risk in obese people of wound infection, chest infection, heart and lung complications, and thrombosis.
- Heart attack or stroke could occur due to the strain on the heart.
- Blood clot in the leg (DVT) causing pain and swelling. In rare cases, part of the clot may break off and go to the lungs.
- Death as a result of this procedure is possible.