Breast Conserving Surgery or Lumpectomy or Wide Local Excision

The palpable cancer or DCIS are removed with a surrounding rim of normal breast tissue.  This is usually done as day surgery, but you may stay in overnight.  At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound.  You can shower as normal.  I will see you usually within 2 weeks and remove the dressing in the clinic. 
 
Hookwire guided excision is used when the lesion or area that needs to be removed is not palpable and therefore difficult to locate at the time of surgery.  A guidewire is necessary to mark or locate the correct area that needs to be removed.  It is a very fine wire, around 1mm in diameter.  The insertion of the guidewire is done by radiologist in the morning prior to your surgery.  It may be done at Bowen, Boulcott or Wakefield hospital. 

Mammogram or ultrasound is used to position the wire into the correct area.  Your surgery is done under general anaesthetic.  The surgeon will remove a piece of the breast tissue around the Hookwire.  Whilst you are still under general anaesthetic the specimen with wire in situ will be X-rayed again to check that the correct area has been removed.  At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound.  You can shower as normal.  I will see you usually within 2 weeks and remove the dressing in the clinic.  This is usually done as day surgery, but you may stay in overnight.

Mastectomy

It involves removing the whole breast.  It is performed when breast conserving surgery is not possible or you choose to have mastectomy.  You can expect to be in hospital for 1 night.  At the end of the procedure you will have a drain placed.  The drain collects any fluid from under your wound.  District nurses will come to your place daily to check on the drain.  It usually stays in place for 1-2 weeks. At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound.  You can shower as normal.  I will see you usually within 2 weeks and remove the dressing in the clinic.
After and before surgery you should start shoulder exercises to prevent shoulder stiffness.  Your physiotherapist will show you these while in hospital and it is important that you continue these after the surgery.

Sentinel Node Biopsy

This is performed when lymph nodes in the armpit are not clinically (on ultrasound or palpation) involved by cancer.  Sentinel lymph node is defined as the first  lymph node that the cancer is likely to spread.  During this procedure sentinel lymph node(s) are removed and examined  by pathologist to determine whether cancer cells are present there.  
A radioactive dye +/- blue dye (Patent Blue) are injected in theatre into the breast.  The surgeon finds the radioactive nodes using a probe (Geiger counter) or finds the blue lymph nodes.  This is usually done at the same time the primary cancer/DCIS is removed.  This may be done via same incision as the one used to remove the cancer/DCIS or separate incision in the armpit is necessary.
At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound.  You can shower as normal.  I will see you usually within 2 weeks and remove the dressing in the clinic.  This is usually done as day surgery, but you may stay in overnight.

Axillary Node Dissection

This is performed when the lymph nodes in the armpit are involved.  The number of the lymph nodes removed vary from person to person.  All the lymph nodes in the armpit that are below the axillary vein are removed. 
This is usually done at the same time the primary cancer/DCIS is removed.  This may be done via same incision as the one used to remove the cancer/DCIS or separate incision in the armpit is necessary.
At the end of the procedure you may have a drain placed.  The drain collects any fluid from under your armpit.  District nurses will come to your place daily to check on the drain.  It usually stays in place for 1-2 weeks.
At the end of the operation your wound will be closed with dissolving sutures and waterproof dressing (Comfeel or Duoderm) is applied over the wound.  You can shower as normal.  I will see you usually within 2 weeks and remove the dressing in the clinic.  You are likely to stay in hospital overnight. Possible

Complications of Breast Surgery

  • Bruising – is common and disappears with time

  • Haematoma – blood can collect under the skin (haematoma) and cause swelling, discomfort and hardness.  It usually resolves, but rarely may need surgery to remove it.

  • Wound Infection – this is also unusual.  TYhings ot look for are spreading skin redness, discharge from the wound or around the drain, worsening pain in the wound, warm and swollen wound and feeling unwell with flu-like symptoms.

  • Change in Sensation – some will occur in the skin because sensory nerves to this area have been affected by the surgery.

  • Seroma – fluid will collect in wound in small or larger quantities.  If it causes discomfort it may need to be removed using a syringe.  This is not a painful procedure.

  • Cording – are the tight strands that you may feel in your armpit after the surgery and may impair your shoulder movement.  The best prevention is exercise to minimize the scarring in the area.

  • Lymphoedema – see the next section

Returning to Work 

The average return is 1-3 weeks depending on the type and duration of your surgery.  This will also depend on the type of work that you do.  Most people start driving within 2 weeks. Legally you cannot drive, work with heavy machinery, make any important decisions, sign important documents or drink alcohol within 24 hours following general anaesthetic.