Breast Cancer Surgery

Breast cancer surgery is done to remove cancer tissue from the breast and prevent it from spreading to other body parts. Depending upon the stage of cancer, the type of surgery to be performed is decided. Mastectomy is a procedure where complete removal of the affected breast is done whereas, in a lumpectomy, only the breast lump and some of the surrounding tissue is removed from the breast with cancer. Further treatment with X-rays (radiotherapy) is required in cases where only the lump is removed.

Surgery is the most commonly used method for treating breast cancer. It is done to remove the original tumour present in the breast and prevent its further spread to other body parts.

There are different types of breast cancer for which surgery is done, such as:

• Ductal breast cancer
  This cancer originates in the ducts or tubes, which carry milk to the nipples.
• Lobular breast cancer
  It originates in the lobules, which are the milk-producing glands in the breasts.

The cost of breast cancer surgery can range between 1.5 to 6 lakhs, depending on the type of health facility (public or private), which includes the cost of investigation, surgery, and radiotherapy. However, there are a few hospitals that provide free of cost breast cancer treatment to almost 60-70% individuals. These are the Tata Memorial Hospital, Mumbai, Kidwai Memorial Institute of Oncology, Banglore, Tata Memorial Hospital, Kolkata, Regional Cancer Centre, Thiruvananthapuram, and Cancer Care Foundation of India.

Before removing cancer from your breast, the surgeon needs to ensure that you’re fit to undergo surgery. Thus, the following things may be done prior to the surgery:

• Some important investigations like blood tests, urine test, X-rays, and CT scans may be done a day or two before surgery.
• Your doctor may ask you about any previous surgeries or current medications that you’re taking.   
• If you have any underlying medical condition, such as diabetes, high blood pressure or thyroid disorders, do inform your doctor.
• The doctor will tell you if you need to stop or start taking certain medicines before and on the day of surgery.
• In case you smoke or consume alcohol, inform your doctor and stop their consumption one or two weeks before the surgery otherwise it will severely affect its outcome.
• You will be advised on when to stop eating because it is very important to be empty stomach during the surgery.

Questions you can ask your doctor

It is important that you speak to your doctor and get all your questions answered. Here is a list of a few questions you may want to ask regarding the surgery:

• What treatment option do you think is best for me?
• Which type of surgery will be done and why?
• What are the risks and side effects of different types of surgeries?
• Would surgery alone will suffice or will it be combined with other treatment methods like X-ray treatment (radiotherapy) or medicines (chemotherapy)? 
• How much will be the duration and cost of the surgery?
• After the surgery, how long does it take to come back to the normal routine?
• How long will be the hospital stay after surgery?
• After surgery, when can be the surgery for the reconstruction of a new breast be done?
• Will the reconstruction of the breast affect my normal activities?
• Can I get in touch with other women who have undergone the same surgery?

On the day of surgery

Before you undergo surgery, the following points should be considered:

• Avoid eating or drinking anything 6-8 hrs before the scheduled time of surgery so that you do not vomit.
• Ask your friend or a relative to take you to the hospital and drive back after the surgery.
• Take the prescribed medicines before the procedure, if any, with a small amount of water.
• Sign your consent to the surgery, which is very important for a doctor to start the procedure after your approval.

The type and extent of breast cancer are the deciding factors to which type of surgery will be done. Before the surgery is done, other methods for treatment can be used to shrink cancer and reduce its size. These are:

Radiotherapy  

A procedure in which X-rays are used to destroy cancer cells or prevent them from multiplying, thus decreasing the size of cancer so that it can be removed easily. This treatment can also be given after surgery so as to kill the remaining cancer cells.

Chemotherapy

In chemotherapy, medicines are given orally or as injections to kill cancer cells. Your doctor may start your chemotherapy before surgery to reduce the size of a large tumour or after surgery so as to ensure no more cancer cells remain.

Breast cancer surgery is done by a specialist surgeon. Before starting the surgery, you will be put under the effect of a numbing agent (general anaesthesia), which will make you sleep during the surgery.

The surgeon will start by giving a cut in your breast and then one of the following surgeries will be performed:     

Breast-conserving surgery

• In this type of surgery, only the tumour and surrounding breast tissue are removed and the rest of the breast tissue is conserved.
• The size and type of cancer and the size of your breasts are factors that decide how much of the surrounding tissue is to be removed.
• This is done to ensure the removal of any traces of cancer in the surrounding tissue. Radiotherapy is usually given after breast-conserving surgery to destroy any remaining cancer cells.
• Advantages of breast-conserving surgery:
  • The whole of the breast is not removed and only the tumour and edge of the normal tissue surrounding it is removed.
  • Less time is taken to recover from surgery.
  • Very little change is seen in your body appearance and therefore, it gets easier to accept it for most women and helps them emotionally.
• Disadvantages of breast-conserving surgery:
  • Additional treatment with radiotherapy is required.
  • It cannot be done in case of a large tumour.

Mastectomy

​It is a procedure where the breast is completely removed including the nipple. The surgeon may also remove some of the lymph nodes (structures which filter tissue wastes in your body) of your armpit on the same side to ensure the removal of cancer cells that might have translocated into them.

• Modified Radical Mastectomy
  It is a procedure in which breast is removed along with the nipple and areola and some of the lymph nodes in the armpit.
• Radical Mastectomy
  This procedure involves removal of the skin covering the breast, muscles in the chest and lymph nodes in the armpit.
• Skin-sparing mastectomy
  It involves a very little amount of skin removal. The breast is removed along with nipple and areola.

While performing the surgery, the surgeon may remove the tissue from the lymph nodes to look for the spread of cancer. After the surgery is done, the surgeon will close the cuts by giving stitches and a dressing will be put. To remove the extra fluid from the operated area, one or two waste draining pipes are left intact.

• Advantages of mastectomy:
  • The risk of cancer recurrence is reduced because it removes 95% of the breast tissue.
  • Additional treatment with radiotherapy is not given in most cases.
• Disadvantages of mastectomy:
  • This procedure involves removing your breast entirely along with some skin around it.
  • Breast reconstruction is required after mastectomy.
  • Recovery time is longer than that in breast-conserving surgery.

The spread of cancer to other body parts

When cancer spreads to other body parts (bones, lungs, liver, brain and so on)
it is called metastasis. It can be treated with the following treatment methods:

• Hormone Therapy
  There are hormones in the body, which can cause certain cancers to grow. Hormone therapy is a treatment, which lowers the level of these hormones in your body and prevents the growth of cancer cells. Hormone therapy may be started before or after surgery and is to be continued for approximately five years after surgery.
• Targeted Therapy
  In this type of treatment, you will be given such medicines which will only kill the cancer cells and not harm the normal cells.

Breast Reconstruction Surgery

Breast reconstruction is about rebuilding the shape of the breast after breast removal surgery (Mastectomy) is done. Reconstruction of the breast may be done during or after some time of the surgery. For rebuilding the breast, the surgeon may either use tissue from your own body (for example, lower belly, back or buttocks) or breast implants.

Implants are plastic sacs, which are placed behind your chest muscles under your skin. However, they may not last for a lifetime and subsequent surgery may be required later. The side effects of implant reconstruction include pain and infection in the surgical area. Sometimes, rupture of the implant may also occur. In some cases, both implants and tissue from the body can be used for rebuilding the breast.

The cost of breast cancer surgery depends upon the type of surgery and ranges from 1.5 lakhs to 3.5 lakhs.

Once your surgery is over, there are a few things you need to keep in mind, such as:

• You have to visit the hospital within two weeks to get your stitches removed. If adhesives were used, they will automatically dissolve with time.
• The dressing given over the wound should be changed every day.
• The wound area should be kept clean and dry.
• Wash the wound area gently with mild soap and water and never scrub it.
• You may take a shower after two days of removing the waste draining pipes or as per your doctor’s advise. Avoid soaking in bathtubs or going into swimming pools.
• You can wear a soft, comfortable wireless bra after the wound has healed and after the doctor tells you that there is no need for putting the dressing anymore.

There are a few things that you may experience after surgery. These are discussed below:

• Pain and stiffness in the arm and shoulder.
• Infection.
• Swelling and heaviness in the arm in case of lymph node removal.
• Difficulty in moving the arm.
• In case an implant is placed to rebuild your breast, it may harden and result in pain.
• In some cases, the implant might fail for which another surgery has to be carried out.

The time to recover also depends upon the type of surgery you underwent:

• Breast-conserving surgery: 5-10 days
• Mastectomy: 3- 4 weeks
• Mastectomy with reconstruction: 6-8 weeks or longer

After surgery, give your body some time to recover and take care of the following things:

• Going for short walks can be started after one to two days of surgery as it increases the blood flow and promotes healing.
• Take a few weeks to gradually shift to your normal routine.
• You can perform some simple exercises as suggested and trained by your physiotherapist.
• To avoid any strain in the operated area, excess physical activity should be avoided.
• Do not lift any heavy objects and avoid any vigorous exercises for 6-8 weeks as it may result in a rise in your blood pressure and bleeding in the operated area.
• Add vegetables and fruits to your diet to fulfill the nutritional demand of the body.
• Ask your doctor about mastectomy bras. These can be used after the surgery and are mostly available in pharmaceutical stores.  

Regular follow-ups are necessary to ensure everything is in place and the wound is healing as expected. Here’s a list of things you need to do while going for a follow-up:

• Make visits to the hospital for the regular medical checkups.
• Tell the doctor about any health problem you are facing.
• To see how well you are recovering from your cancer, your doctor may advise you to undergo X-ray tests.
• Immediately call your doctor if you have:
  • High fever.
  • Increasing pain which is not getting relieved on taking medication.
  • Side effects, such as nausea, vomiting, rashes from any of the medicines.
  • Lack of sensation or numbness.
• After the treatment is done, mammogram screening is carried out every year for at least five years to check for recovery and ensure no new cancer cells are forming.

After surgery, most women get back to normal routine and the success of the surgery depends upon the following factors:

• The stage in which the cancer is detected, which is determined by the size of the tumour and whether it is only in breast or has involved other body parts also.
• The type of breast cancer you have.
• How rapidly the breast cancer is spreading.
• What are the chances of the tumour to recur?
• Whether you have been diagnosed with cancer for the first time or it has come back.
• It also depends upon your age, health status and menopause status (whether you are having your menstrual cycle/periods or not).