The operation that is right for you.
Every breast and every cancer is different, so which operation is right for you depends on the person in front of us, not a fixed routine. We talk it through with you before anything is decided.
Removing the cancer
Mastectomy
Mastectomy means removing the entire breast, including the area containing the tumour. There are different types:
- Radical mastectomy — the breast tissue, skin and nipple are removed along with the underlying muscles and the lymph nodes in the armpit.
- Modified radical mastectomy — the breast tissue, skin and nipple are removed along with the lymph nodes, but the underlying muscles are preserved. This is the most common type of operation traditionally done for breast cancer.
- Simple mastectomy — the entire breast tissue, skin and nipple are removed, but the muscles and lymph nodes are preserved.
- Skin-sparing mastectomy — the entire breast tissue and nipple-areola complex are removed, but the overlying skin is preserved, like an envelope.
- Nipple-sparing mastectomy — the entire breast tissue is removed while preserving the skin and the nipple-areola complex.
Afterwards, you may notice some soreness, pain, tingling or numbness, and stiffness in the arm, depending on how the axilla has been addressed. A surgical drain — a plastic tube attached to a box — is usually placed to prevent fluid collecting, and is removed after seven to ten days.
Breast conservation surgery
This describes a technique where the tumour is removed with a margin of normal tissue around it. The margin is checked intraoperatively using a rapid technique called frozen section, to make sure it is free of tumour. Alongside this ‘lumpectomy’, the axillary lymph nodes are addressed separately, using either sentinel lymph node biopsy or a complete axillary dissection.
Breast conservation surgery is safe, with local recurrence rates comparable to mastectomy, and lets you stay tumour-free while keeping your breast and body image. It is usually combined with oncoplasty — a technique that keeps the size and shape of the breast well maintained. Radiation therapy for three to five weeks is compulsory afterwards.
Breast conservation is possible in most cases of early breast cancer, and in some cases of locally advanced disease after neoadjuvant therapy. It is not suitable for inflammatory breast cancer, or for anyone who cannot have radiation therapy. Where there is more than one tumour, the decision has to be made case by case.
The lymph nodes
Sentinel lymph node biopsy
This is a procedure in which the first draining lymph node is identified and removed. Traditionally, everyone having breast cancer surgery had all their axillary lymph nodes removed, which could lead to shoulder stiffness, numbness and the possibility of lymphoedema — swelling in the arm. To reduce this, sentinel lymph node biopsy is now used for node-negative breast cancer, and in certain cases after chemotherapy.
Two dyes are used to identify the first draining nodes, which are then removed and sent for rapid testing called frozen section. Whether any further lymph nodes need to be removed depends on whether cancer has involved the sentinel node. This helps us improve your quality of life without compromising your oncological safety.
Axillary lymph node dissection
This involves removing all the axillary lymph nodes at level I and II, and sometimes level III. It is the procedure of choice for addressing the axilla when the lymph nodes are already known to contain cancer, and is done together with either mastectomy or breast conservation surgery.
Afterwards, you may notice shoulder stiffness, numbness, swelling in the armpit (a seroma), or lymphoedema — swelling in the arm. A surgical drain is placed to prevent fluid collecting, and is removed after seven to ten days. We teach arm exercises to help movement and reduce the chances of swelling.
Shape and reconstruction
Oncoplasty
Oncoplasty is the surgical technique used during breast conservation to make sure the tumour is removed with clear margins, while leaving you with a cosmetically acceptable breast. It combines oncological surgery with plastic surgery methods.
Depending on the size and shape of your breast, the size and number of tumours, how close they are to the skin and nipple, your age, other health conditions, breast density and several other factors, we choose from a range of oncoplasty techniques so that, after surgery, the breast looks as close as possible to the other one. Sometimes local breast tissue is used to fill the defect; sometimes tissue is taken from elsewhere to get a good result.
Reconstruction
After mastectomy, you have the option of whole breast reconstruction — recreating the breast. It can be done immediately, at the same time as the mastectomy, or delayed, at a later date once all other treatment is complete. Reconstruction can be done using:
- Implants — artificial devices made of silicone.
- Your own body tissue — taken from the abdomen, back or buttocks.
We discuss whole breast reconstruction, and its pros and cons, with every patient while planning their mastectomy.
Benign and diagnostic procedures
Lumpectomy for benign lumps
Even without breast cancer, you may need surgery to remove a breast lump that has been shown to be benign. Lumpectomy may be needed for:
- Fibroadenomas — if they are large, causing a cosmetic problem, or there is doubt about whether they could be cancer.
- Phyllodes tumour — a rare type of breast tumour that can grow large and needs to be removed with a margin of normal tissue.
- Papillary lesions, and others.
These are day-care procedures, done in a way that keeps the size, shape and look of the breast unchanged afterwards.
Duct excision
If you have pathological nipple discharge — discharge that is blood-stained, watery, profuse, from a single duct, or spontaneous — surgery may be needed after a thorough evaluation.
Microdochectomy removes a single milk duct using specialised surgical techniques. If multiple ducts are affected, or you have recurrent episodes of duct infection (periductal mastitis), you may need a radical or total duct excision instead. These, too, are day-care procedures, done in a way that keeps the size, shape and look of the breast unchanged afterwards.
Chemoport
A chemoport, or vascular access device, is placed to make it easier to give chemotherapy to patients who need multiple intravenous doses over a long period.
It is a simple procedure, done under local anaesthetic or sedation, that places an implantable port under the skin. The catheter attached to the port is inserted into the internal jugular or subclavian vein.
Wire-guided excision
This procedure is used for lesions that cannot be felt. Sometimes an abnormality is found on a mammogram that cannot be seen or felt on examination; in patients who have had neoadjuvant chemotherapy before surgery, the tumour may also shrink so much that it can no longer be felt.
In these cases, a wire is used to correctly mark the tumour so we can remove exactly the right area. On the morning of surgery, the radiologist places the wire under ultrasound or stereotactic guidance, which guides us during the procedure.
Contact
You will be looked after.
Clinics at Indraprastha Apollo Hospital and Apollo Athenaa Women's Cancer Centre, with video consultations six days a week.
| Location | Days | Time |
|---|---|---|
| Indraprastha Apollo Hospital, Sarita Vihar | Tue, Thu, Sat | 2:00 – 4:00 PM |
| Apollo Athenaa Women's Cancer Centre, Defence Colony | Mon, Wed, Fri | 10:00 AM – 12:00 PM |
| Video consultation | Mon to Sat | 11:00 AM – 12:00 PM |