Breast Cancer
Breast Cancer Risk assessment
Breast cancer is a malignant growth of the glandular tissue of the breast and one of the most common cancers (2nd in causes of cancer-related deaths). The liftime risk of developing breast cancer is 1:8 and many women with breast cancer do not have any family history of the diease.
Therefore it is important to be breast aware and look after yourself fortunately, with improving surgical techniques and adjuvnat therapies , the mortality of breast cancer has seen a significant decline in last 30 eras.
Currently, the Breast Screen program in Australia offers free screening with second yearly mammogram for women from the age of 50-74. However, it is imperative to perform regular breast checks yourself. It is also important to book a yearly clinical breast assessment/ examination with your GP and seek medical attention if any concern arises. No concern is too small to ignore.
Dr Trinh will take a detailed family history and ascertain your risk of carrying the mutated gene. You can then refer onto Genetic Counseling for consideration of genetic testing if indicated. If you have high risk of breast cancer or carry gene mutation, you will need more intensive surveillance
Choices and information about your breast cancer surgery
Lumpectomy or Wide Local Excision
This procedure allows to have the lump removed with an adequate margin of surrounding tissue. This is recommended in selected cases with early small breast cancer and it will be carried out in a way to ensure the best cosmetic outcome. It will also depends on tumour to breast ratio. Dr Trinh will explain to you the placement of the scar and the expected result.
The operation is performed under general anaesthetic in hospital as a day case. In addition, some lymph nodes in the armpit (axilla) will be sampled (sentinel lymph node biopsy) to check for metastasis (cancer cells spreading to lymph node), or axillary clearance (removal of all lymph nodes) will be performed if lymph nodes are found to contain cancer cells. You will almost always be recommended to have radiation therapy after operation. This is to reduce to the risk of cancer recurrence in the breast. Lumpectomy with radiotherapy has been proven to be as effective as mastectomy in reducing risk of cancer recurrence.
Oncoplastic Surgery
This is the integration of the latest plastic surgery technique into breast cancer surgery to allow an optimal cosmetic outcome in addition to achieving excellent local control. Cosmetic breast procedures can be incorporated into the breast cancer operation, such as: Mastopexy (breast lift) Reduction mammaplasty (breast reduction) Breast augmentation (breast enhancement)
Dr Trinh is extensively trained and experienced in oncoplastic surgery to offer you these latest techniques. Depending on the size of the cancer in relation to breast size and shape, your surgeon will discuss with you this option. In addition to removing the cancer, your breast might need remodelling such as a dual planes intramammary flap, nipple reposition, local flaps (e,g: lateral/ anterior intercostal perforator flap), breast reduction/ breast lift etc. to allow for excision of a larger tumour and also to improve the cosmetic outcome. Oncoplastic surgery includes volume displacement (using local breast tissue0 or volume replacement techniques (using surrounding tissue or implant)
Therapeutic Reduction Mammaplasty This uses the breast reduction/breast lift technique incorporated with breast cancer surgery to allow the excision of a larger tumour and still leave patients with a good cosmetic result. Patients with macromastia/ large breasts are suitable for this technique, which will also improve the distressing symptoms associated with macromastia, such as: Shoulder grooving Neck and back pain Skin rash
Neoadjuvant Chemotherapy
In some well selected cases, the patient might be offered a choice to have chemotherapy before surgery. As the tumour will shrink with chemotherapy, this might increase your chance of having breast conserving surgery instead of mastectomy. This has been shown to be as effective as the traditional use of chemotherapy after surgery, and in addition, reduce the need for mastectomy.
Mastectomy
It is less likely that you will require radiation therapy after operation, however, it would ultimately depend on the type/ size and status of lymph node involvement of tumour. There are three types of mastectomy: Simple mastectomy: involving the removal of skin, nipple and breast tissue. The result is a scar across the chest wall. This procedure is tolerated by majority of patients with minimal risk. If you choose this option, you can wear a prosthesis in the bra. Our Breast Care Nurse will assist you with measuring and ordering a suitable prosthesis. There is financial assistance from Medicare with purchasing a prosthesis. Skin Sparing mastectomy: the nipple and areola are removed but the skin envelop is left behind for a better coverage of reconstruction with autologous flap or implant. Nipple sparing/ Total skin sparing mastectomy: the breast tissue are excised leaving behind skin envelope and nipple with areola. This will allow for a better cosmesis in selected cases. This technique has been shown to be safe in breast cancer patients, with no significant increase risk of cancer recurrence.Your surgeon will discuss with you the options of mastectomy, with either immediate or delayed reconstruction.
Breast ReconstructionThere are mainly two types of breast reconstruction: with flap (using your own tissue) and with implant. However, either of these options often will require a longer operation time with higher risk of complications and might require two or more operations to achieve the desired result.
Autologous flap reconstruction techniqueThis technique uses your own muscle and skin from another part of the body to rebuild the breast shape. Flap reconstruction can also be combined with implant reconstruction to achieve the desired cosmetic result. Types of flap reconstruction are: Latissimus dorsi muscle reconstruction: this technique rotates the broad muscle and skin on your back to your front chest wall. TRAM flap reconstruction: this technique uses the muscle in your abdomen to rebuild breast shape. The abdomen is then reinforced with a synthetic mesh to prevent hernia. DIEP flap reconstruction: this technique uses the skin and fat in the abdomen to rebuild breast shape.
Implant reconstructionBreast implant prosthesis is filled with silicone gel or saline (salt water solution) and have a silicone envelop. The reconstruction can be performed as 1-stage or 2-stages depending on the type of mastectomy and your need/timing for radiation/chemotherapy. The implant is always placed under your pectoral major muscle, a muscle on your chest wall. This is to reduce risk of implant protrusion, and infection. However, new techniques involving placement of the implant in front of the muscle in selected cases have also proven to have excellent cosmetic result.
One stage implant reconstruction is immediate placement of implant or flap during the same operation as mastectomy. Two stage reconstruction often includes the placement of a tissue expander, a temporary implant which allows for injection of saline solution and gradual stretching of your skin to reach your desired breast cup size. This is followed by a second operation where the tissue expander is removed and a definite silicone implant will be placed in the pocket.
Nipple reconstructionNipple reconstruction will be offered to patients who had the nipple removed as part of breast cancer surgery treatment. Skin on the chest wall is used to reconstruct nipple or skin graft technique can be employed utilising skin from another part of the body. Nipple tattoo can result in matching nipple areola colouring and resemble normality.
Adjuvant Chemotherapy/ Radiation therapy/ Endocrine therapy
These are treatments that can be recommended following surgery depending on your pathology result. These aim to reduce risk of cancer recurrence and improve survival. Dr Trinh participates in Multidisciplinary team including dedicated Breast Cancer Medical Oncologist, Radiation Oncologist and Breast Care Nurse through Nepean Cancer Care Centre to provide you the best of wholistic care.
Breast Cancer Information
We have found these resources helpful in providing more further breast cancer information
Cancer AustraliaCancer Council of New South WalesBreast Cancer Network AustraliaNational Breast Cancer FoundationBreast Screen New South WalesBreast Surgeons of Australia and New ZealandAustralian Society of Breast DiseasesAustralia and New Zealand breast cancer trials group and Breast Cancer Institute of AustraliaClinical Oncology Society of Australia