Breast Cancer

WIDE LOCAL EXCISION

The aim of this surgery is to remove the cancerous lump with a clear margin of normal breast tissue from around the lump. The operation will be performed under a general anaesthetic. The surgeon will make a cut into the skin of the breast directly over the lump. A continuous stitch will be used to sew up the wound. The cosmetic results of this operation are usually very good as most of the breast is conserved.

Wide Local Excision with Auxiliary Clearance. (i.e. removal of lymph glands from the arm pit on the affected side).

Wide local excision is explained above. Some patients will have their glands removed from their arm pit as well as removal of the breast lump.
This is done for two main reasons:

* Firstly it gives us an idea as to whether the cancer has spread into the glands from the breast and will determine any future treatments that may be needed.

* Secondly, if the cancer has already spread into one or two of the lymph glands it treats the area.

The lymph glands are situated in the arm pit at three levels and we aim to take as many of the glands as we can from all three levels. Usually, it is necessary to make a separate cut in the arm pit to remove the lymph glands.

Is there an alternative?
It is important that the cancerous lump and a clear margin of healthy tissue is removed. Another option for treatment is to remove the entire breast. However, many patients who have early, localised breast cancer can be offered surgery to conserve the breast followed by a course of radiotherapy to the remaining breast tissue.

The surgeon will discuss your individual situation with you.

After Surgery.
When you return from the operating theatre you will have two long tube suction drains in position attached to plastic bottles. The drains will be collecting fluid from your arm pit and breast wound. The drains will stay in position until the volume of fluid collected in 24hrs is 30mls or less. The nurses will check the levels each day, usually at midnight.

You may feel some soreness or discomfort around the wound area but we would aim to control this with painkillers.

The breast and arm pit wound will be covered with a clear film like dressing, it is impermeable to water so you will be able to wash as normal. However, please avoid using deodorant in the arm pit area until the stitches have dissolved and the area is completely healed, about two to three weeks after surgery.

You may experience some stiffness or numbness of the shoulder and upper arm on the affected side. This is because the surgeon has had to part two or three large nerves in order to remove the lymph glands. This usually improves within a few weeks, but the numbness may take some months to settle.

It is important to do the arm and shoulder exercises after surgery as this will help maintain comfort and mobility of the area. The Physiotherapist will help you.

You will usually be allowed home when the fluid draining from the wound lessens and the drainage tubes are removed. This is usually about 5 - 7 days after the operation. It may be possible to go home with your drain still in position providing you are able to return to the ward on a daily basis to have the drain checked by the nursing staff

You will be given an appointment to return to the Breast Clinic to have any stitches removed (usually 10 - 14 days after surgery) and to discuss the results from your operation. Very occasionally, the results of the microscopic examination may suggest further surgery, otherwise you will be given an appointment to see Dr. Lowdell, the oncologist (cancer specialist) to discuss any further treatments.


This picture shows a good cosmetic result after
breast conserving surgery and radiotherapy

Self care at home.
The wound dressing should remain in place until you return to clinic. The support of a soft bra may help the wound feel more comfortable.

Sometimes tissue fluids can accumulate under the skin around the wound or armpit area causing the skin to feel swollen or tense and uncomfortable. If you become aware of this then ring the breast unit and we will arrange for the Doctor to see you. The fluid will usually be drained with a needle and syringe.

Wound infections may occasionally occur. If you feel feverish or notice any discharge or signs of inflammation such as: a hot feeling around the wound, redness, tenderness or swelling, contact the breast unit or your G.P.

You are likely to feel tired and need to rest more for the first couple of weeks at home. This can vary from person to person but usually after about six weeks you will feel more able to cope with your usual level of activity. You should refrain from any lifting, driving or strenuous housework such as window cleaning, hoovering etc. for about a month.

Try to increase your level of activity steadily, but slowly and continue with your arm exercises. Use your arm as normally as possible, but, if you have had your lymph glands removed it is important to be aware that your natural response to infection or injury affecting that arm is not quite as efficient as it was. It is wise to take extra care in certain situations to lessen the chance of injury to the arm. You will be given a separate booklet discussing this in more detail.

Some swelling of the arm may occur within the first few days of your operation and will usually then settle down. Resting your arm on a pillow, preferably with your elbow at a higher level than your shoulder, can help.

Return to work will depend on your individual circumstances, the doctor or nurses will discuss this with you.

These clinical images demonstrate an excellent cosmetic result after a wide local excision on the right breast

You may also find that you feel many strong emotions at this time as you are trying to come to terms with what has happened. The support of an understanding partner or friend can be invaluable. Some people also find that talking to someone who has been in similar circumstances can be helpful. Breast Cancer Care have a volunteer network and can be contacted on 020 7384 2344 or on Nationwide Freeline 0500 245 345. Please remember that the breast care nurses are also available to discuss your concerns and to offer support and advice.

If you are concerned about your progress in any way let us know.

If you require further advice or information please contact the
Macmillan Breast Care Nurses, Hazel Ricard and Hilary Rickwood on 020 8565 5885

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