Types of Surgery

Excision Biopsy

This term is generally used to describe removal of a breast lump without the removal of extra breast tissue surrounding the lump. This operation is commonly performed when the lump is benign or indeterminate.

Breast Conserving Surgery

Removal of a cancerous breast lump with a cuff of normal tissue around it. The term “wide local” excision is also used to describe this type of surgery. Most patients having breast conserving surgery have some form of axillary procedure at the same time. The term breast conserving surgery includes a wide range of procedures from simple removal of the tumour with a cuff of normal tissue to larger procedures such as “therapeutic mammoplasty”.

This procedure is a specialist interest of Mr Davies and involves using a cosmetic breast procedure – a breast reduction – to treat breast cancer. This allows large volumes of tissue to be removed, gives wide margins of excision of the cancer itself, immediate symmetry with smaller more manageable breasts and perhaps less side effects from other follow on treatments for cancer such as radiotherapy.

Please visit the research paper Mr Davies has written for details on this approach (link to annals TM paper PDF). All breast conserving surgery performed by Mr Davies involves local reconstruction of the breast using plastic surgical techniques to avoid any visible defect following surgery.

Simple Mastectomy

This removal of the breast and nipple alone

Skin Sparing Mastectomy

Removal of the breast and nipple through a cosmetic incision around the nipple preserving most the breast skin. This operation is commonly combined with immediate breast reconstruction.

Sentinel Node Biopsy

See separate section on sentinel node biopsy. recent research trials have suggested than in certain patients with a positive sentinel node is may not be of benefit to go on to have further surgery to remove further axillary nodes.

This decision is made at a multidisciplinary meeting and depends on how much cancer is present in the sentinel node. The deposit can be measured as a "micrometastasis" which is a group of cancer cells measuring less than 2mm in diameter, or a "macrometastasis" which is greater than 2mm. If the sentinel node contains a micrometastasis, then no further surgery will be recommended.

In most but not all cases with a macrometastasis, further surgery – a "clearance" of the axillary lymph nodes – is recommended. In this situation most, but not all of the lymph nodes may be removed which will mean extra precautions to prevent lymphedema in the future will be necessary. View research article

Axillary Clearance

The term axillary clearance (Level II or III) or axillary dissection broadly mean the same thing, that is removal of most of the axillary lymph glands. This is in contrast to sentinel node biopsy, which is an assessment of only one or two axillary lymph glands. Axillary clearance is performed following sentinel node biopsy if it is positive, or initially if the lymph glands are likely to contain cancer cells (e.g. large tumour in the breast).

Breast Reconstruction

This term is used describe reconstruction of the breast mound. This can be performed to reconstruct defects following breast conserving surgery,  immediately at the time of total mastectomy, or at a later date (delayed reconstruction). There are many ways of performing breast reconstruction.