Breast Surgery

 

Breast Surgery
 
The management of breast diseases, mainly breast cancer have undergone a great paradigm shift. Radical ablative surgeries are a thing from the past. We are now moving towards minimally invasive procedures with effective results.
 
Breast surgeries are often divided into:
 
a) Surgery for benign disease
b) Surgery for malignant disease
c) Cosmetic breast surgery.
 
(A) SURGERY FOR BENIGN BREAST DISEASE
 
Lumpectomy
 
This surgery involves simple excision of a lump in the breast. The incision site is often chosen for best cosmetic outcome as well. The scars are often small and well placed.
 
Microductectomy
 
When a patient presents with abnormal nipple discharge and associated ductal lesion the procedure of choice is a microductectomy which involves the removal of the entire affected ductal system. The scars are small and well placed. The entire ductal system removed is sent for pathology.
 
Aspiration of Cysts
 
Breast cysts are very common and almost 100% benign. Surgery is not required for simple cysts. These cysts if large or symptomatic are easily aspirated under ultrasound guidance by a trained breast surgeon or radiologist.
 
Surgery for Gynecomastia
 
Gynecomastia means enlarged male breasts. It may be unilateral or bilateral. Often it affects young males in their adolescence as a result of hormonal imbalance or childhood obesity. It is also triggered by certain drugs when used in prolonged periods by older men. 
 
Here the surgery involves a subcutaneous mastectomy ie. Removal of the breast tissue via a small incision often circum-areolar. The breast tissue is removed and patient often has an overnight stay in hospital and may require post operative drains depending on the size of the breasts.
 
Surgery for Inverted Nipples
 
Some people may be born with inverted nipples. The condition can be corrected surgically via small incisions if patient chooses to do so.
 
(B) SURGERY FOR CANCERS
 
Wide excision (breast conserving surgery)
 
When the tumor is small in relation to the breast and located a safe distance from the nipple areolar complex, wide excision with adequate margins is the procedure of choice. This procedure is combined with a sentinel node biopsy or axillary clearance.
 
Mastectomy 
 
Mastectomy involves removal of the entire breast tissue and overlying skin. The decision to do the mastectomy is based on various factors including breast size, number of lesions, biologic aggressiveness of a breast cancer, the availability of adjuvant radiation, and the willingness of the patient to accept higher rates of tumour recurrences after lumpectomy and radiation.  Often it is also a patient’s choice. It can be done alone or combined with an immediate reconstruction.
 
Skin sparing mastectomy and immediate reconstruction
 
Here, the entire breast tissue is removed via a small entry through the nipple areolar complex. The overlying skin is retained completely. It is combined with immediate reconstruction using implants or autologus tissue. The cosmetic results are very good. It is a safe procedure and subsequent treatments are carried out as usual without delays. 
 
Sentinel Node Biopsy for Axillary nodes
 
This is the GOLD STANDARD in the management of breast cancer today. It is a precise procedure done to locate the first draining lymph node of the cancer using specialized technique of radioactive isotope and dye. It requires full training and accreditation to perform this procedure.
 
The lymph node removed is immediately assessed with frozen section to confirm if it is involved with cancer or not. If it is clear, then no further surgery to the lymph nodes is needed. If it is involved with cancer ONLY then an axillary clearance is needed.
 
It has great advantages of small incision, no drains required and possible discharge from hospital on the same day as surgery.
 
Axillary Clearance
 
This procedure involves the removal of 2/3 of the axillary nodes. (Level I & II clearance)
It involves extensive dissection in the armpit often leading to post operative complications such as pain, stiffness, weakness and lymphedema (progressive swelling of the limb).
 
(C) COSMETIC BREAST SURGERIES
 
Breast reduction surgery 
 
Women with abnormally large, pendulous breasts, suffer from chronic pain of the head, neck, back, and shoulders, plus circulation and breathing problems due to the weight of their breasts and benefits from breast reduction surgery. This is performed on individuals with fully-developed breasts, and it is not typically recommended for women who desire to breastfeed.
 
Breast Augmentation
 
 A breast implant is a prosthesis used:
 
*  to alter the size, form, and feel of a woman’s breasts in post–mastectomy breast reconstruction.
*  for correcting chest wall congenital deformities.
*  for the aesthetic enhancement of the bust
 

Our Doctors Specializing In Breast Surgery

Dr Harjit Kaur

MBBS, MS (UKM), FRCS (Ire), AM (Mal), Fellowship in Breast Surgery (Aust)
Specialty: Breast Surgery, Endocrine Surgery
Location : Prince Court Medical Centre , Gleneagles Hospital Kuala Lumpur