It is likely that you will be offered surgery. The extent of this can vary considerably – from the removal of an isolated lump to removal of the whole breast.

In general, a lump is removed (excised) if only one small area of the breast is affected.  In other words, if the cancer is confined to a distinct area.  The lump is normally removed with a 1cm margin of healthy surrounding tissue. More than 80% of breast cancers are now detected early enough to be suitable for this type of surgery.

If your cancer has been detected by a mammogram and cannot be felt, then a procedure called localisation will be used to pinpoint the exact area to be removed during surgery.

The radiologist will use a mammogram as a guide to insert a fine wire into the specific breast area.  This can take up to an hour and can be uncomfortable.  Once the wire is in place, another mammogram will be done to check its location.  It is likely that the wire will then be covered with a comfortable padded dressing and left there until surgery  usually the same day.

If the whole breast is removed, this is referred to as a mastectomy.  In general, the nearby lymph nodes in the armpit are likely to be removed during this surgical procedure.

Several possible types of mastectomy are described in more detail below:

Partial  in this case the cancer does not have a clear outline; therefore a larger amount of tissue than for a lumpectomy is removed alongside the cancer tissue

Simple  in this case just breast tissue is removed  it may be a preventative measure if you are at an increased risk, such as by the identification of a specific genetic mutation in BRCA1 or BRCA11

Radical  in this case the entire breast is removed, including the pectoral (chest)and axillary (armpit) muscles, and other nearby mesenchymal (connective) tissues.

Modified radical  in this case, whilst the entire breast is removed the nearby lymph nodes are left intact.

What to expect

Once the breast tissue has been removed, a drainage tube is placed in the affected area to remove the blood and lymph that can accumulate in the wound during the healing process.  You will wake up with this drainage tube already in place and it is likely to be left in for a couple of days.

Following the operation, be prepared to experience possible losses or altered sensation in the upper arm skin and restrictions and weaknesses in your arm and shoulder movements for a while.

These are both generally temporary issues and should gradually improve as healing progresses.  You may be given exercises to help this process along.

Cording

Some people may develop a pain that can feel like a tight cord running down from the armpit through to the back of your hand that can reduce your arm movements.  This is termed cording, due to the appearance of raised cord-like structures visible along the arm.

Cording is thought to be due to hardened lymph vessels.  It can appear anything from 6-8 weeks after your surgery up to many months afterwards.  Usually the symptoms will fade.

Losing a breast

Losing a breast, or part of a breast, is a major emotional trauma and you may be overwhelmed by some of the feelings that you experience once the operation is completed.

After the initial shock of a cancer diagnosis and the actual surgery has passed, you may experience a whole range of feelings related to the emotional and sexual implications of your operation  from grief for your lost breast to insecurity about your femininity  both entirely normal reactions.

Give yourself time to adjust to the new you.  You may feel unable to look at your scar initially but dont put it off too long.  Bear in mind that the area around the surgery will be looking its worst in the days and weeks immediately after the operation.  Any swelling and bruising will disappear and your scar will soften and fade as the healing process continues.

02/06/2009