Breast

endo
Endocrine
12/04/2014
head&neck1
Head & Neck
23/04/2014

Breast

Breast Surgery

Most women with breast cancer have some type of surgery. Operations for local treatment include breast-conserving surgery, mastectomy and sentinel lymph node biopsy or removal of axillary (armpit) lymph nodes

Breast Cancer

Every woman has a chance of developing breast cancer. Other than skin cancer, breast cancer is the most common cancer in Australian women When breast cancer is diagnosed early, it can often be treated successfully. With proper treatment, most women who develop breast cancer survive, and are able to live long, normal, and healthy lives.


Surgical Procedure

The type of breast conservation surgery will depend on the size, location of tumour, and amount of tissue that has to be removed during the procedure. Breast conservation surgeries can include lumpectomy or partial mastectomy.

Wide local Excision or lumpectomy

lumpectomy involves the removal of the cancerous lump with a margin of the surrounding healthy breast tissue. Lumpectomy can be performed under general or local anaesthesia, and may take about 15-40 minutes. Your surgeon will use an electric scalpel (blade) to make a curved incision across the natural curve of your breast and will remove the tumour along with the surrounding healthy tissue.Another incision near the armpit is made if your surgeon decides to remove the lymph nodes as well. The lump will be sent to the lab to test for the presence of tumour cells in the healthy margin tissues, and the incisions will be closed.

If cancer cells are present in the surrounding tissues removed with the tumour, your surgeon will perform an additional surgery ( at a later time )called as re-excision lumpectomy, by re-opening the lumpectomy site and removing a larger margin of the breast tissue.

Partial mastectomy

Partial mastectomy (segmental mastectomy or quadrantectomy) involves the removal of more breast tissue containing cancer, surrounding healthy tissue, and the chest muscles underlying the tumour. It is performed under general anaesthesia.This procedure is often accompanied by a mammoplasty to improve the cosmetic result .

In certain cases, your surgeon may perform a sentinel lymph node (first lymph nodesin your armpit or axilla) to which cancer cells are most likely to spread) biopsy to test for the presence of cancerous cells. If the cancer has spread to the sentinel lymph node, your surgeon may remove the remaining lymph nodes at another operation time

Following breast-conservation surgery, you may have to undergo radiation therapy, chemotherapy or hormone therapy in combination, to destroy any residual cancerous cells still remaining in the breasts.
The various types of mastectomy procedures include:
  • Simple or Total Mastectomy: Your surgeon will remove the entire breast and sometimes the lymph nodes from the armpit by making a 6 to 7-inch long elliptical cut starting from the inside of the breast, close to the breast bone, and continuing up and out toward the armpit.
  • Skin-Sparing Mastectomy: Your surgeon will cut an opening around the nipple and areola to remove the breast tissue. Most of the breast skin is preserved with this technique, which is generally lost in traditional mastectomy. It offers the advantage of negligible scarring and provides the best option for immediate breast reconstruction.
  • Preventive/prophylactic or risk-reduction mastectomy: If you are genetically predisposed and have a high risk of developing breast cancer, you may choose to have preventive surgery. A simple mastectomy or nipple-sparing mastectomy can be performed

Sentinel Lymph Node Biopsy

What is a sentinel lymph node (SLN)?

The sentinel lymph node is the first lymph node ("gland")in your armpit or axilla to receive lymphatic drainage from a tumour. It is the sentinel, or "guard" of the rest of the lymph nodes. If the sentinel node is free of cancer cells, there is a >90% chance that the rest of the lymph nodes are also free of cancer.

What is SLN biopsy?

SLN biopsy is a procedure in which the sentinel lymph node is identified, removed and examined under a microscope to determine whether cancer cells are present. SLN biopsy is based on the idea that cancer cells spread (metastasize) in an orderly way from the primary tumour to the sentinel lymph node(s), then to other nearby lymph nodes.

Axillary ( armpit)Lymph node dissection: The removal of the lymph nodes is an important step in breast cancer surgery as the cancer cells can spread to the other parts of the body through lymph. Your surgeon can remove five to thirty lymph nodes,an irregular pad of fatty tissue which contains lymph nodes,or sentinel nodes, which are the first lymph nodes into which the cancer cells can spread.

Thyroid Surgery

Surgery on your thyroid maybe needed if your gland is overactive( toxic), there is a lump that is suspicious for cancer or the gland has enlarged to distort other structures in your neck

Thyroid cancer is an abnormal growth of the cells of the thyroid gland, a butterfly-shaped gland located in the front of your neck just below the voice box (larynx). Thyroid gland secretes hormones that help regulate the body’s metabolism (and levels of calcium). Thyroid cancer is more common in women than men. People who are exposed to high levels of radiation to the neck and have a family history of thyroid cancer and goitre (enlargement of thyroid gland) are at a higher risk of developing thyroid cancer.

Generally, surgery involving thyroid gland removal is the most common treatment of thyroid cancer. Total thyroidectomy is a surgical procedure to remove all of the thyroid gland. Subtotal or partial thyroidectomy is a surgery to remove part of the thyroid gland. Your doctor may also remove the lymph nodes if the cancer has spread to the lymph nodes. The surgery is performed under general anaesthesia. The surgeon removes the thyroid gland by making a 3-inch to 4-inch incision in the middle of your neck, on top of the thyroid gland. A small tube (catheter) will be placed into the area to drain the accumulated blood and fluids.

Thyroidectomy carries a risk of bleeding and infection, damage to your parathyroid glands resulting in low calcium levels in your blood. There is also a risk of damage to the nerves connected to your vocal cords and larynx, which can cause, hoarseness, coughing, swallowing problems, or speaking problems.