Can I avoid a mastectomy

What is Mastectomy?

Mastectomy is the surgical removal of the breast for the treatment or prevention of breast cancer. This surgery is recommended to patients whose breast cancer is relatively large compared to the breast size (cancer occupying more than one quadrant of the breast). This procedure has come a long way from the one originally described by Halsted in 1894 (removal of the breast, underlying chest wall muscles and lymph nodes from armpit), to removing only the breast tissue and even sparing the skin and nipple (skin sparing mastectomy). Majority of patients undergoing this procedure are offered immediate reconstruction, as long as they are fit to withstand prolonged surgery.

Can I avoid mastectomy?

Most breast cancers are treated by breast conservation. However, despite the large size of the breast cancer, it is still possible to save the breast. It requires a multidisciplinary approach. As oncoplastic breast surgeons, we offer the following procedures to save the breast

1) Therapeutic Reduction:

This is similar to breast reduction as described in the cosmetic section. The same techniques can be applied to small breasts. It usually requires opposite breast procedures i.e. breast reduction or breast lift.

2) Neoadjuant Treatment:

This means that patients can have medical treatment to reduce the size of the tumour before the surgery. This can be achieved with tablets which block the hormones or chemotherapy.

3) Local Perforator Flap (LICAP, IICAP, MICAP):

Please read the section below for details.

LICAP, IICAP, MICAP
Lateral, Inferior or Medial Intercostal artery perforator flap breast reconstruction

What is it?

These local flaps aim to restore the size and shape of your breast by replacing lost breast tissue from the cancer surgery, with skin and fat taken from the side of your chest wall and back. Muscle is not removed during this procedure, therefore causing no affect to your arm or chest wall function.
Women choose to have this surgery as it allows for the appearance of a natural breast avoiding the need for a mastectomy or complex reconstruction.

Why I might need it?

If you’ve been diagnosed with breast cancer, we can help. We understand how hard cancer is on both your body and mental health – and right now all you probably want is to get back to some kind of normal life. Traditionally, if you have a large tumour it would require a mastectomy with breast reconstruction. However, if your cancer is on the outer part of your breast occupying a quarter of your volume, you may be suitable for a LICAP thus avoiding the need for a mastectomy. Removal of such a large cancer leaves a large defect causing asymmetry. By choosing to have LICAP, this defect can be reconstructed at the time of your surgery to restore the size and shape, leaving you with a natural looking breast.

What are the benefits?
  1. It avoids mastectomy even for large tumours.
  2. One can avoid implant or other complex reconstruction as it uses your own tissue.
  3. It minimises the need for opposite breast symmetrising surgery as the natural shape of the breast maintained.
  4. Quicker recovery.
What does the procedure involve?

On the morning of your surgery, your consultant will draw markings on your skin to show where the incisions will be made. Your consultant will need to map out the underlying blood vessels to ensure a good blood supply to the flap being used to fill the defect in your breast- this will be done by using a hand held Doppler.

A photograph may be taken from the neck down before and after your surgery for records and comparison. Your consultant will ask you to sign a consent form to show you are happy with this. This will remain anonymous.

The operation usually takes 3 hours. Once your tumour has been removed, your surgeon will use the tissue from the side of your chest wall and back to reconstruct the space left in your breast. All of the lymph node surgery (if required) will be performed through the same scar thus leaving you with no scars on your breast (unless your underlying cancer is close to the skin needing skin to be removed from the breast).

You will be left with a long scar on the side of your chest going towards your back. Over time, this will fade and is mostly hidden under your arm and bra strap.

You do not need drains as a routine after this procedure unless it is combined with Axillary Lymph Node clearance. Drains are used to allow serous fluid to drain from the surgery site, to keep you comfortable. Your consultant will explain this to you.

What is the recovery period?

The usual recovery period for this procedure is 3-4 weeks. Your scar may feel tight but should relax after a few weeks. A physiotherapist will give you some gentle exercises to perform at home which are vital to ensure you regain full shoulder movement.

You will need to wear a soft breast support for the first week and then a soft, non-wired bra will be suitable for the following 3-4 weeks.

You will need to sleep on your back for the first 2 weeks. It is advised that you refrain from driving for the first 2 weeks and normal strenuous activities can be resumed gradually from 6 weeks.

What complications can happen?
  • Bleeding / infection causing pain and swelling
  • Blood clots in legs and lungs (Deep vein thrombosis &
  • Pulmonary Embolism
  • Seroma
  • Wound breakdown
  • Flap failure
  • Tightness in scar
  • Altered sensation
  • Shoulder stiffness