Breast cancer surgery

The surgical removal of a tumour from the breast is a fundamental part of breast cancer treatment. The optimum surgical treatment is determined in interdisciplinary collaboration between gynaecological, oncologists and surgeons. The individual needs of the patient play an important part in the process. Nowadays, breast-preserving surgery is possible for the majority of women. A breast amputation (mastectomy) is only undertaken in exceptional cases, i.e.  if breast-preserving surgery is not an option. If the breast needs to be removed, there are different breast-reconstruction procedures.

Breast-preserving surgery in patients with breast cancer

During the breast-preserving surgery, only tumour tissue from the breast is usually removed.  The affected lymph nodes near the tumour are also removed if they are available. Chemotherapy is sometimes carried out before the surgery to initially reduce the size of the tumour. This upstream therapy is known as neoadjuvant treatment.

What preparations are carried out before the procedure?

Different clarifications and examinations are undertaken before the procedure. The tumour is located precisely with medical imaging procedures such as mammography, ultrasound and MRI. A biopsy determines the type of cancer. Based on the examination results, the doctors then decide whether breast-preserving surgery is possible and whether chemotherapy should be carried out beforehand.

All the usual pre-operative assessments, such as a blood test, blood pressure measurement and an ECG, are also required beforehand. All blood-thinning medication must be discontinued prior to surgery.  The operation is carried out under general anaesthetic and the patient must have an empty stomach at the time.

How is the operation carried out?

The location of the tumour in the breast determines where the incision is made in the skin. Then, the tumour tissue is removed from the breast. In the process, the surgeon operates with a safety margin of a few millimetres of healthy tissue. In this way, he or she can ensure that the tumour is completely removed. If lymph nodes near the tumour are affected, these are these also surgically removed. If smaller defects in the breast occur as a result of the tumour tissue being removed, these are usually repaired during the same breast-preserving surgery. If there are major defects, the breast reconstruction takes place in a subsequent operation. The procedure takes one to two hours.

What is the success rate of this procedure?

The success rates after breast-preserving surgery depend on the stage and type of the cancer. The recurrence rate during the breast-preserving surgery is not larger than after breast removal and the prognosis is not worse. The decision to undergo breast-preserving surgery is only made if the prospects of recovery are not impacted.

What are the possible complications and risks of this procedure?

This is a low-risk operation and usually proceeds without complications. As with all surgery, the operation may lead to infections, post-operative haemorrhaging or blood clots (thromboses) in rare cases.

What happens after the operation?

After the surgery, the patient is monitored during the recovery phase as they wake up from the anaesthesia. If everything proceeds normally, you can usually leave hospital two or three days after the operation. You should avoid lifting heavy objects and major physical exertion for some time after the surgery.

The treatment for breast cancer is continued. Radiotherapy is usually carried out concomitantly to the surgery to minimise the risk of relapse. Depending on the type of breast cancer and the stage, chemotherapy, hormone therapy or immune therapy must also be carried out.

Mastectomy, breast amputation, breast removal

Breast removal is required when breast-preserving therapy is not possible. Indications for a mastectomy can be: the tumour is too large, has grown into the nipples or the breast-preserving therapy does not provide a good cosmetic result. Sometimes women also decide to undergo breast removal because they want to avoid radiotherapy, or they feel better if the entire breast is removed.

What preparations are carried out before the procedure?

The pre-operative assessments before a breast removal are the same as for a breast-preserving operation. Generally the surgeon determines before the breast removal whether the first steps of breast reconstruction can also be undertaken during the surgery.

The patient is usually admitted to hospital on the day before the surgery. All the usual pre-operative assessments, such as a blood test, blood pressure measurement and an ECG, are also required beforehand. All blood-thinning medication must be discontinued prior to surgery.  The operation is carried out under general anaesthetic and the patient must have an empty stomach at the time.

How is the operation carried out?

In contrast to in earlier times, breast removal is also undertaken as gently as possible. If possible, a part of the skin is retained. Often nipples or areolas or parts thereof are retained. In every case, all the mammary gland tissue and the fascia (connective tissue) of the breast muscle under the breast is removed. The breast muscle itself is not removed. If lymph nodes near the tumour are affected, these are also surgically removed. Depending on the situation, the initial measures for breast reconstruction with tissue or silicone implants are made.  The procedure takes two to three hours.

What is the success rate of this procedure?

The success rates after breast-preserving surgery depend on the stage and type of the cancer. Relapse after breast removal is comparable with that of breast-preserving surgery.

What are the possible complications and risks of this procedure?

Breast removal is a low-risk operation and proceeds without complications. As with all surgery, the operation may lead to infections, post-operative haemorrhaging or blood clots (thromboses) in rare cases. Sometimes lymphostasis (lymph oedema) can occur in the arm after removal of the lymph nodes in the armpit.

What happens after the operation?

After the surgery, the patient is monitored during the recovery phase as they wake up from the anaesthesia. If everything proceeds normally, you can usually leave hospital three to five days after the operation. You should avoid lifting heavy objects and major physical exertion for some time after the surgery.

The treatment for breast cancer is continued. Radiotherapy is usually not required after the removal of a breast.  The further treatment is based on the type and stage of the breast cancer. It can include chemotherapy, hormone therapy or immunotherapy.

Breast reconstruction

There are various options and procedures available for reconstruction of the breast. Silicone implants are often used to reconstruct the breast. Sometimes implants containing saline are first inserted before the actual reconstruction starts. The patient's own tissue from their abdomen or back can be used as an alternative to silicone implants. During this method, a skin-fat flap with or without muscles is removed and transplanted onto the breast. The breast construction with autologous tissue is also complex and harder on the body than the insertion of implants. The medical situation and the individual preferences of the patients will determine the best method in the individual case. The breast reconstruction usually already begins with the breast cancer operation, and takes place in steps. If radiotherapy is required, the breast reconstruction is not performed until after the radiotherapy.