Oncoplastic Surgery and Lymphnodes
Whenever possible, we prefer to use a breast conservation therapy (BCT) for breast cancer. In BCT, only the part of the breast affected by the tumor is removed. However, if the tumor is larger, is located in an unfavourable position, or if the breast is very large or sagging, a so-called oncoplastic operation can be useful. Oncoplastic means that the tumor is definitely removed and the breast is then comprehensively reshaped. Thus, oncoplastic surgery is virtually an extended BET. With this technique, larger tumours can be removed easily and safely, while at the same time the resulting "holes" are filled with tissue from the breast. This technique is usually used for sagging or very large breasts. With this technique, it may also be necessary to adjust the size and shape of the breasts to each other if asymmetry occurs.
It is important that we remove the tumour "R0". "R0" means that no tumor remains in the breast and the margins are cleared. The margins are evaluated under the microscope by the pathologist (histology). In most cases, the breast should be irradiated after oncoplastic surgery to reduce the probability of recurrence in the breast.
Oncoplastic Surgery and Lymphnodes
In oncoplastic surgery, the tumor in the breast is removed. However, breast cancer can also spread to lymph vessels and lymph nodes. In the past, all lymph nodes were removed from the armpit (axilla). Today, we look for the first lymph node that drains the lymphatic fluid from the breast, the so called sentinel lymph node (SLN). If the SLN is affected by cancer, depending on the type of tumor, further lymph nodes can be removed from the axilla, or the axilla is later irradiated together with the breast.
To find the SLN a special medication is injected into the skin of the breast before the operation. This migrates along the lymph vessels into the SLN, which we locate during surgery with a special device.
If the SLN contains cancer cells, we usually have to extend the therapy. In order to improve the chances of healing, the SLN removal and examination is therefore very important.
The ideal breast for oncoplastic surgery is large or sagging (or both). This makes it easy to remove the tumor and reshape the breast from the remaining tissue. In some cases, it may also be useful to adjust the shape and size of the other breast to ensure that the breasts are symmetrical.
Lymph node removal is usually performed in the same operation.
Surgery takes place under general anaesthesia. The skin incisions are discussed beforehand and depend on the position of the tumor in the breast and the extent of the reshaping. If the tumor is not palpable, it is marked with a wire through the skin beforehand so that we can find it better and remove only the tumour and the adjacent tissue. This increases precision. The breast is then reshaped so that no "hole" remains in the breast. Drains are sometimes inserted to drain off wound fluid. The tumor is then examined under the microscope by the pathologist. We usually get the results after a few days.
The removal of the SLN or, if necessary, of several lymph nodes from the axilla is usually done through a separate incision, or if the breast tumor is located near the armpit through the same incision.
As with all operations, you should stop smoking to minimize the risk of wound healing disorders. You can get up after the operation. We recommend a light (sports) bra as a bandage and to relieve the strain on your breasts. You will stay in hospital for about 1 to 3 days. Initially the breast will look swollen and possibly "dented". This is normal and will disappear in the next few weeks. If only the SLN is removed from the axilla, one usually notices little in the armpit or on the arm. If several lymph nodes have to be removed, a temporary numbness may occur in the armpit or on the inside of the upper arm. After about 4 to 6 weeks, the breast and, if necessary, the armpit can be irradiated.
Acute complications are extremely rare. However, as with any surgical procedure, there are certain risks, such as bleeding, infection or wound healing disorders. The swelling and sutures in the breast can cause asymmetries and irregularities, which usually disappear later. Excess wound fluid rarely needs to be punctured. You can minimize the risks by not smoking and by eating a protein-rich diet. Removal of lymph nodes in the armpit can lead to temporary or permanent lymph congestion (edema) in the arm in rare cases and in very rare cases in the breast. This can usually be treated well with decongestive lymph drainage. We will discuss the exact risks in detail during the consultation.
Further Therapies
Surgery is important but only one pillar of breast cancer therapy. It is important that after surgery it is determined on our interdisciplinary Tumor Board at the BrustCentrum whether and which further therapies are still necessary to complete the treatment and improve healing.
ONCOPLASTIC SURGERY
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Contact
Please make a consultation appointment in advance. Appointments can be made by telephone, online or e-mail contact.
Prof. Dr. med. Hisham Fansa, MBA
Facharzt für Plastische, Rekonstruktive
und Ästhetische Chirurgie (FMH)
Head of Plastic Surgery
Address
Spital Zollikerberg
Trichtenhauserstrasse 20
CH-8125 Zollikerberg
Contact
Phone: +41 44 397 38 60
E-Mail: plast.chir@spitalzollikerberg.ch
www.spitalzollikerberg.ch