Breast conservation surgery is a procedure available to certain patients. Your breast surgeon will inform you if you are a candidate for breast conservation surgery.
To be a candidate for breast conservation surgery, some specific prerequisites must be met. Some prerequisites include the size of your breasts, the size and location of the tumour and your ability to receive radiation.
One of the reconstructive options available to a patient with an adequate tumour to breast ratios is wide local excisions via a reduction pattern.
During breast conservation surgery, the breast cancer surgeon removes the tumour and a rim of surrounding normal tissue. A pathologist will assess the excised breast tissue to make sure that the tumour is completely excised. Rearrangement of the remaining breast tissue is done in such a way as to reconstruct the breast mound via breast reduction techniques.
Breast reduction patterns approach the breast via incisions that surround the nipple and areola, a vertical component with or without a horizontal component – the so-called inverted T-incisions. These incisions facilitate the movement of the nipple and areola into a new position and removing breast tissue, fat and skin. Once the breast tissue is excised, arrangement of surrounding breast takes place to give a cosmetically pleasing shape.
The breast size is reduced to accommodate the oncologically excised tissue. Should you wish to have an even more significant reduction, that too can be accommodated. The amount of breast tissue removed is determined by the oncological requirements firstly and secondly by patient preference.
The reconstructive surgeon arranges the breast tissue and moves the nipple and areola into its new position. In most cases, the nipple and areola remain attached to their blood vessels and nerves. However, if the breasts are very large and pendulous, the nipples and areolas may have to be removed entirely and grafted into the correct position. The graft will result in complete loss of sensation in the nipple and areola. In cases where the tumour is close to the nipple and areola, placement of a clear disc of the skin in the position of the nipple and areola allows for nipple and areola reconstruction at a later stage. Once again, all sensation will be lost as the nipple and areola are removed.
In Post Breast Conservation Surgery, the patient receives radiation therapy. Radiation therapy affects the breast in various ways and thus has to be compensated for, if possible, during the initial reconstruction. These changes include, but are not limited to:
- Loss Of Volume: To account for loss of volume, the breast operated on will, initially, be made slightly larger than the opposite breast.
- Fat Necrosis: Death of fatty tissue and formation of hard lumps. These may be managed conservatively and may perhaps be best not to interfere and cause further fat necrosis. The reconstructive surgeon may elect to excise the hard tissue or inject some fat to improve the condition.
- Skin Changes: Breast conservation surgery via reduction techniques is a safe procedure, but as with any surgery, there is always a possibility of complications. These include bleeding, infections and anaesthetic related complications. The procedure leaves noticeable, permanent scars and some patients have poor healing around the nipples and at the inverted T-junctions, worsened by smoking.
You will receive a general anaesthetic. The reconstructive surgeon draws the appropriate access incisions on your breast either before or during the procedure.
Firstly, the oncological surgeon removes the breast tissue and necessary lymph nodes via the predetermined incisions. The pathologist determines adequate tumour removal intra-operatively, and once the margins are clear the reconstructive surgeon proceeds.
The breast tissue gets arranged in a way to accommodate the excised tissue and to reduce the breast to the required size. The nipple and areola are positioned in the appropriate position, grafted or replaced by a clear disc depending on the oncological and size requirements. The opposite breast gets reduced similarly.
Two drains are placed – one in each breast. These drains will remain until the drainage is less than 30ml in 2 consecutive days. The wound is closed in layers, and appropriate dressings applied.
The patient is placed in a supportive bra intra-operatively. Thus, It is essential that the patient come to the theatre with an appropriate sports bra without any wire insertions, preferably in a dark colour.
You would have to stay in the hospital for 2-5 days during the healing process. We will teach you how to empty the surgical drains and to keep a record of the drainage.
We will prescribe and provide Antibiotics and pain medication for you to take home. The drains will be removed once it drains less than 30ml in 2 consecutive days.
Do not rush to get back to work. Allow yourself 6 weeks for recovery. You will not be allowed to drive for two weeks following the procedure and will need to follow up with both the reconstructive as well as the oncological surgeon on the dates given at discharge.
Pain, bruising and swelling will gradually disappear over the next few weeks, and slowly your breast will settle into the new shape. This process may take six months to a year. You will be required to wear supportive bras for up to 4 months.
Below follows a list of some of the more frequent complications associated with breast conservation surgery via breast reduction techniques:
- Local Complications (Around The Breast):
- Haematoma formation
- Seroma formation
- Delayed wound healing
- Wound sepsis
- Wound breakdown
- Sensory changes in the breast
- Systemic Complication (Your Body):
- Fluid and electrolyte abnormalities
- Deep vein thrombosis
- Postoperative lung complications
- Long Term and Cosmetic Complications (The Way It Looks):
- Asymmetries of the breast nipples (pre-existing asymmetries will still be noticeable)
- Poor scarring
- Dog Ears and irregularities of the wounds
- Change in the sensation of the nipple and surrounding breasts
- Inability to breastfeed post-operatively
- Complete nipple loss
- Pain, from many causes including muscle spasms and nerve injury
- Secondary procedures to improve the appearance, e.g. fat fills