Breast surgery

Mr Justin James

Surgical care of breast conditions needs close interaction of radiologists, nuclear medicine services workers, breast care nurses, physiotherapists, and surgeons. Most breast surgical procedures can be performed as day surgery procedures. Careful preparation and planning and post-operative care together produce best outcomes in breast surgery.

Before surgery

Breast surgeon aims to diagnose accurately the type of disease and its extent before the actual surgical procedure. This will involve appropriate imaging investigations like mammogram, ultrasound scan, or MRI. A breast biopsy will often be performed to confirm the diagnosis. Most of the breast surgeries will be performed under general anaesthesia. Preanesthetic check-up by the anaesthetic team may be necessary in some cases. Surgeons will need all previous imaging results and films during the procedure, and hence, it is important that you bring them along on the day of surgery. You will need to undergo fasting for the general anaesthesia.

Surgery for benign breast conditions

Surgery may become necessary in some of the benign breast conditions like an enlarging benign lump, nipple discharge, or lumps that are suspicious on scans or mammogram. The breast surgeon aims to complete this operation through best cosmetic incision possible; however, scars are inevitable. Most of these surgeries are performed as day cases, and in some cases, radiology guidance will be necessary to direct surgery.

Surgery for breast cancers

Breast cancer surgery involves careful selection of surgical option and its skilful execution A brief description can be found here.

Risk-reducing surgery

In patients who have more than average or high risk of breast cancers, prophylactic excision of breasts is an option to reduce their risk of developing a breast cancer. These types of surgeries can be followed by immediate breast reconstruction. Careful planning and discussion is needed before performing this type of surgeries. Detailed information can be found here.

Post-operative care

Drain tubes

Following some surgeries like mastectomy or axillary dissection, small plastic tubes are used to drain fluid that may be collected in the wound. These tubes may remain for a variable period of time depending on the type of surgery and type of discharge. This will be removed during post-operative review or by nurses at the appropriate time.

Post-operative pain control

Analgesics and local anaesthetics are administered during the operation, which help to reduce the pain after the operation. You may need some pain killers to stay on top of the pain after the operation, which will be organised at the time of discharge after operation.

Post-operative mobility and exercise

Once you recover from the effect of anaesthesia, you will be able to sit up, eat and drink, and start to mobilise. You can become more and more mobile and independent in the following hours to days depending on the surgery and your preoperative general health. Gentle exercises will be encouraged within a few days aimed to increase mobility of the shoulder and the arm.

Post-operative wound care

You may have one or two wounds depending on the type of surgery. These wounds are closed using dissolvable internal sutures. Wound will be dressed with waterproof dressing.

You may be able to wet this dressing to an extent; however, it is advised that you keep this area as dry as possible. If dressing remains clean, this may be left alone until you are seen for post-operative review, which usually happens within a week. However, if the dressing is soaked, itchy, painful, or visibly soiled, it may need to be changed sooner. You may have to contact us or see your GP to change the dressing.

Possible post-operative problems

Bleeding

Immediate or delayed bleeding can sometimes occur after breast operations. When it is small and gradual, often, it results in bruising around the operation site, which will settle over a few weeks. If bleeding is significant and leads to collection of blood in the wound, it may need a second surgery to remove this blood and control the bleeding.

Wound infection

Infection of the wound leads to excessive pain, redness, discharge from the wound, fever, or feeling unwell. Some of the early infections may be treated with antibiotics. Occasionally, further procedures may become necessary to remove pus or fluid within the wound. If any of the above symptoms occur, it is best that you contact us or your doctor as soon as possible.

Seroma

Body fluid collecting within the wound after operation is called seroma. It leads to fullness or swelling at the operation site. Most of these will settle over time. Seromas sometimes need removal by needle aspiration.

Altered sensation

Breast and axilla surgeries result in some amount of altered sensation, numbness, or pain in the breast or under the arm. These changes may improve to an extent in the post-operative period. Numbness under the arm that occurs after lymph node surgery often tends to be permanent.

Lymphoedema

Axilla surgery to excise the lymph nodes can lead to this late complication occasionally. This is due to excessive tissue fluid collection in the upper limb. Steps to prevent this and physical therapy are the mainstay of management of this problem. More information can be found here.