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Breast Cancer

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What is breast cancer?

Breast cancer starts in the ducts or lobules of the breast. Cells lining the ducts or lobules can grow out of control and develop into cancer. Some breast cancers are found when they are still confined to the ducts or lobules of the breast. This is called pre-invasive breast cancer. The most common types are ductal carcinoma in situ (DCIS) and lobular carcinoma in situ (LCIS). Most breast cancers are found when they are invasive. This means the cancer has spread outside the ducts or lobules of the breast into surrounding tissue. Invasive (infiltrating) ductal cancer is the most common type of breast cancer, accounting for eight out of ten cases, invasive (infiltrating) lobular cancer is the second most common accounting for one in ten cases. There are other less common types of breast cancer including inflammatory breast cancer.

There are several categories of invasive breast cancer.

Surgical procedures for breast cancer

Most women with breast cancer have some type of surgery. The main purpose of surgery is to remove as much of the cancer as possible. Surgery is also undertaken to find out whether the cancer has spread to the lymph nodes.

Mastectomy

Mastectomy is the removal of the whole breast and usually includes the removal of the nipple. Mastectomy is recommended if the tumour is large in comparison to the rest of the breast or there are multiple tumours in the breast.

If breast conserving surgery is performed and cancerous cells are found in the surgical margin a mastectomy may need to be performed.

The scar from a mastectomy extends across the skin of the chest and into the armpit.

The lymph nodes are situated deep within the skin. The number of lymph nodes present in the armpit varies from person to person. The examination of these lymph nodes by a pathologist is the most powerful prognostic indicator available, it allows doctors to determine the extent of the cancer and determine the best treatment plan.

At Concord Hospital we use a Bio impedence machine.  This allows us to do regular monitoring of women at risk of developing lymphoedema. Secondary lymphoedema is one of the most significant causes of morbidity in post-operative breast cancer patients.  It is associated with adverse physical and psychosocial effects and often has a profoundly negative effect on daily life.  

Effective treatment of secondary lymphoedema requires both an early, sensitive and specific diagnosis technique as well as therapeutic intervention that reduces the severity or incidence of the condition. The aim of this initiative is to assess breast cancer patients who undergo surgery, pre- and post-operatively in order to appropriately implement early intervention and therefore improve their quality of life.

Here, at Concord Hospital we work very closely on a daily basis with the occupational therapist who assists with the management of lymphoedema in breast cancer patients.

Breast Conserving Surgery

This is the removal of breast cancer and a small amount of healthy tissue around it (the surgical margin).  This is sometimes called a wide local excision and is usually a one and a half hour operation. Radiotherapy to the breast after surgery is usually needed.

After breast conservation surgery you will have a waterproof dressing over the surgical incision.  If lymph nodes are removed from your armpit, a drain (plastic tube) will be inserted under your arm.  The drain gets rid of blood and fluid from the operation that your body does not need.  This will last from five days, up to ten days, depending on the amount of drainage.

This is a way of examining the lymph nodes without having to remove them all. A radioactive substance and a dye are injected near to the tumour. This is carried by the lymphatics to the first (sentinel) nodes that get lymph from the tumour. This lymph node is the one most like to contain cancer cells if the cancer has spread. If the sentinel node contains cancer, further lymph nodes are removed.

Reconstruction

What are your options for Breast Reconstruction?

Breast reconstruction is a very personal decision.  It can be done at the same time as your initial surgery called immediate reconstruction or anytime after, called delayed reconstruction.

At Concord Hospital we have breast specialists that work hand in hand with plastic surgeons to offer a variety of reconstruction options.  Our emphasis is on providing co-ordinated care and support on an individual level.

Types of reconstruction

Tissue expander and Implants:

This is usually a two stage process.  This first stage of having a tissue expander inserted behind the muscle in your chest (pectoral muscle). Once this has been done you will have to see your doctor every week for a total of 5-6 visits having small amounts of saline injected into the expander through a magnetic port.  Like filling a balloon with saline.  Once the skin has been stretched to the correct size to suit your body the second stage starts.

Second stage:  This involves the removal of the tissue expander and the insertion of the permanent implant.  This stage usually happens between 6-9 months after stage one.

Note:  This type of reconstruction usually cannot happen after radiotherapy as it causes the skin to tighten and decrease in elasticity.  Thus the skin does not stretch.  The surgeon will assess your skin and tell you if he can offer this.  

Tissue or Flap Reconstruction:

Breast Reconstructive surgery allows patients that have undergone treatment for breast cancer to have a more natural appearing breast formed than that created with implants. The size of the breast will change as the patient gains or looses weight over time.

TRAM Flap, involves transferring muscle, fat and skin from the abdomen to the breast to form a new breast.  This operation will not be possible if you do not have enough fat on your stomach area.  

DIEP Flap, deep inferior epigastric perforators, only removes the skin, fat and inferior epigastic vessels to transfer to the chest to form a new 'breast'.

Lat Dorsi, This reconstruction involves the movement of the muscle, skin and fat in the back to the chest forming a 'breast', this may be used in combination with a saline implant to enhance the size to match the other breast.

Nipple Reconstruction
This is the last stage of the reconstruction process.  Skin is used from your breast or another part of the body to form a nipple.  Then coloured with tattooing to match the other nipple.

LINKS

NSW Cancer Council - Breast Cancer
Talking to Kids about Cancer