Frequently asked questions

Diagnosis of cancer is never easy to discuss and many patients are overwhelmed by this news.

However, I stress to my patients that much can be done these days about this diagnosis and majority of patients can be cured from it, assuming that they undergo all recommended treatment.

It is important to remember that treatment for Breast Cancer is multifaceted.  It includes in most cases surgery, often includes radiotherapy and sometimes chemotherapy.  There is also often a long-term treatment option with anti-hormonal drugs and targeted biological therapy drugs.

Which of these treatments will be advised will depend on the specific nature of your individual cancer and its variations.  Usually a number of discussions are required to make sure you are across all your options and make an informed decision with your doctor.

Do remember that you are in charge of your own treatment and your surgeon is there to guide you and help you make your decisions.

There are many factors that guide treatment decision for Breast Cancer.  These can be grouped into cancer specific factors, patient specific factors and surgeon specific factors.

Cancer specific factors include size, aggressiveness of tumour (grade), margins of resection, hormone and other receptor status, lymph node status, presence or absence of cancer spread outside of the breast to name a few.

Patient specific factors include size of the cancer in relation to the size of the breast, the position of the cancer, the overall clinical scenario, family history and likelihood of genetically inherited cancer, patient’s preference and importance of breast preservation, ability to maintain a lifelong surveillance post treatment, as well as possibly access to post mastectomy reconstruction.  Not least of these factors is the cost of the procedure to the patient.

Surgeon specific factors include surgeon’s expertise and training and ability to offer a range of Oncoplastic approaches or standard approaches only, as well as possibility of reconstruction at the same time or after the cancer removal.

These factors are very fluid and of variable importance in each individual’s case, however, they need to be considered and weighed up by the surgeon and the patient when making decisions about the most appropriate approach.

Short answer is it depends.  It depends on many factors, some of which are cancer specific, some are patient specific and some are surgeon specific.

Assuming the cancer biology allows it and the patient wishes to preserve the breast, it then comes down to the technical expertise of your surgeon.

There are two main approaches to Breast Preservation in Breast Cancer: The Standard approach and the Oncoplastic approach.  Most breast surgeons can offer Standard approach, but only a few at this stage are trained to offer Oncoplastic approach.

Both Standard and Oncoplastic approaches are designed to remove cancer effectively, but only Oncoplastic approach also considers the aesthetic outcome of the operation.  This approach (which involves many different specific techniques, grouped under the name Oncoplastic approach, with the specific technique used depending on the actual situation for individual patient) is designed to improve the final cosmetic result.

It does this by minimising scarring, maintaining shape of the breast and keeping it free of holes/divots and deformity (which may occur with a standard approach) and maintaining symmetry of the breast by addressing the other unaffected breast if required.

An appropriately trained specialist Oncoplastic Breast Surgeon only is able to offer the Oncoplastic approach, due to high level of expertise required to achieve good outcomes.

Therefore, when considering your options it is important to weigh up the goals of the operation and what is an acceptable result for you at the completion of treatment.

There are a number of reconstruction options available for women undergoing breast cancer treatment or surgical prophylaxis.  These can be classified into implant reconstruction or reconstruction using your own tissue.

Implant reconstruction is most often performed at the same time as the removal of cancer operation.  It can be done in a single operation (one stage) or in 2 operations (two stage).

Reconstruction with your own tissue uses your own tissue from another area like back, tummy, buttocks or thigh and brings this around to the breast area to recreate the appearance of the breast.  Some of these “flaps” can be done whilst attached to the original site, whilst others need to be cut from the original site and then reattached to the new location, whilst still others can be done either way.

There are pros and cons to each of these approaches and these needs to be viewed in a specific individual context for a specific patient.  What’s good for one person may not be suitable for the next.

No operation is free of risks and reconstruction procedures certainly carry a number of risks.  Therefore, it is important to consult widely about these decisions and be comfortable with approach and the risks associated with it.  These risks may be reduced by making sure that a well-trained Oncoplastic Breast Surgeon with an interest in reconstruction or a Plastic Surgeon performs your operation.

Perhaps a little surprisingly most patient find that breast surgery is not very painful and is very well managed with post-operative analgesia.

There are commonly two aspects to Breast Cancer surgery.  The breast surgery itself as well as the additional axillary (armpit) surgery that is necessary for some patients.  This may be limited to Sentinel Node Biopsy (which samples lymph nodes from the armpit) or may involve a full Axillary Dissection (where all of the relevant lymph nodes removed from the armpit).

Usually armpit surgery is a little more sensitive post-operatively and can also cause a range of potential complications such as cording (scarring) in the armpit, frozen shoulder (stiff shoulder) and lymphoedema (swelling of the arm), as well sensory changes.

However, overall breast and axillary surgery are very well tolerated and most patients do not require heavy-duty opioid (morphine based) analgesia, apart perhaps from an occasional short interval in the initial period post surgery.