The prospect of breast cancer surgery can be frightening for many living with the disease, but knowing what to expect is vital in alleviating fears. In this article, we walk you through the process of surgery and what to expect during your recovery.
As the most common type of all cancers in the UK – with over 55,000 new cases diagnosed every year between 2014-2016 – it’s hard not to know someone whose life has been affected by a breast cancer diagnosis. This isn’t just because of the prevalence of breast cancer; it’s also because of positive campaigning and information about the disease that has reached so many people in today’s connected world. However, for those who have received such a diagnosis and are currently undergoing treatment, there is still a lot of information about breast cancer that doesn’t often get talked about – such as breast cancer surgery.
There are several different types of surgery that can be performed – and often the type of surgery is related to the stage that your breast cancer is at, as well as the type of surgery that is best for you. In this article, Better Healthcare takes you through what you should expect when going for breast cancer surgery so that you are best prepared for the post-operative breast cancer recovery process.
What you should know about breast cancer
As aforementioned, breast cancer is the UK’s most common type of cancer. While predominantly affecting women, particularly those who are over the age of 50, breast cancer is something that can happen to anyone who has breast tissue – including men. According to Cancer Research UK, around 55,200 cases of breast cancer occurred each year between 2014-2016 and accounted for a whopping 15% of all new cancer cases (2016). Also, approximately 99% of all breast cancer cases occur in women.
There are many different types of breast cancer, including:
- Invasive breast cancer (the most common)
- Invasive lobular breast cancer
- Triple negative breast cancer
- Inflammatory breast cancer
- Male breast cancer
- Many other types of rare breast cancers, breast tissue abnormalities and skin conditions associated with breast cancer
However, it’s not just the amount of new cases of breast cancer that is high in the UK every year; survival rates are high too. In fact, survival rates have increased with every passing decade since the early 1970s. For example, four in ten women survived breast cancer beyond ten years in the 1970s; now, it’s thought to be around eight in ten women. Additionally, nearly nine in ten women survive the disease past five years. While still far from perfect, these stats are an encouraging sign as research into the disease continues.
The risk factors
Many factors affect the chances of developing breast cancer – from lifestyle to long-standing medical conditions. It’s thought that about one in eight women will develop the disease during their lifetime, and about one in 870 men too.
Before we list some of the things that can increase your risk of developing breast cancer, it’s important to note that some people may have most of these factors and still won’t develop breast cancer. Conversely, there are people with none of the factors listed below who have or may develop the disease.
Inherent risk factors (i.e. things you can’t change) include:
- Your family history
- Exposure to radiation (e.g. radiotherapy or x-rays)
- Additional medical conditions
- Hormonal levels
- Giving birth to children later in life or not at all
- Prior cancers
- Breast tissue changes (e.g. DCIS or LCIS)
- Benign breast disease
- Denser breast tissue
- Period-related issues (e.g. if they started early and/or you had a late menopause)
Things you may be able to change (e.g. lifestyle or medication):
- Higher intakes of alcohol
- Taking a contraceptive pill
- Being overweight or obese (according to BMI measurements)
- Inactivity (e.g. not exercising enough)
- Hormone replacement therapy – generally used by women to reduce menopausal symptoms or transgender women (assigned male at birth)
Breast cancer surgery is one of a number of treatments offered for those who have been diagnosed with breast cancer. Options include:
- Targeted therapy
- Hormonal or endocrine therapy
It is not uncommon to find a combination of these treatments being used to alleviate or treat breast cancer symptoms.
Choosing which one is best for you is something that should be done in conjunction with doctors and specialists who you should be able to access through your GP. However, factors that affect which treatment works best can include:
- the type and size of the cancer,
- where it is,
- if it has spread,
- your general health,
- your menopausal status,
- any cell abnormalities, and
- whether or not the cancerous cells are suited to targeted cancer drugs
Unlike other types of cancer, surgery is considered the first step in the treatment process. However, if your cancer is at stage 2 or 3, you may receive pre-operative chemotherapy first in an attempt to shrink the tumour. You may also receive hormonal or targeted therapy if the doctors believe it would suit you to do so.
The goal of surgery is to remove the areas of the breast affected by cancer.
Types of surgery
There are, primarily, two types of breast cancer surgeries performed as well as an additional surgery if necessary:
This is when the cancerous tumour and cells are removed, alongside a ‘margin’ (or ‘border’) of normal breast tissue. This is not just to remove the tumour and the cancerous cells from the affected area, but also to allow for further tests to see if the cancer has spread. The margin of breast tissue is tested and in your post-operative, pathological report, you will be told whether or not your cancer has spread or if you have negative (clear) margins. Negative margins mean that the outer edge of the breast tissue removed is devoid of cancerous cells; whereas positive margins mean that there are signs of the cancerous cells at the edges of the margin.
The most common breast-conserving surgery is lumpectomy (or wide local excision) – this is the option that ensures the most retention of the breast. This will often be done in conjunction with radiotherapy.
The less common breast-conserving surgery is quadrantectomy. This involves the removal or roughly a quarter of the affected breast. As a result of surgery, the breast will either be smaller or a different shape from what it was. Due to this cosmetic difference, a lumpectomy combined with oncoplastic surgery is often favoured as it offers the best chance of favourable aesthetic results.
This is when as much breast tissue is removed as possible – often leading to the removal of the whole breast that has been affected by cancer. This is often chosen as an option if there are multiple areas of cancer that have occurred in the breast, or if the cancer has spread across a large area in the breast.
Breast reconstruction is often offered in conjunction with a mastectomy – which can be performed at the same time as your mastectomy.
Lymph node surgery
If you are dealing with invasive breast cancer, you will likely have the lymph nodes under your arm assessed before the operation to see if they contain any cancerous cells. If found, it will be recommended that your lymph nodes are removed too. This is often performed at the same time as your breast cancer surgery.
The breast cancer surgical procedure
Going to the hospital can be a particularly unsettling experience for some people, so it can be useful to know what to expect before you go, as well as what will happen when you are there, and when you can expect to be back home.
Your first trip will often be to a pre-assessment clinic, not long before the surgery date. This will involve tests to ensure you are fit for surgery (such as blood tests, electrocardiogram, blood pressure, etc.), and the team will also make notes about you, your general health, medications you are taking, and contact details of your GP and relatives. The procedure will be explained to you and you’ll have a chance to ask any questions regarding the surgery.
You should prepare before heading to the hospital. Your consultants will tell you how long you should expect to stay and, as such, you should pack clothes – preferably loose-fitting clothes that can be buttoned or wrapped around you. This is to allow for ease-of-access when getting medical dressings checked by nurses, and also reduces chances of any post-operative pain as a result of trying to pull clothes over your head.
A bra can be worn, but a front-button post-surgery bra or crop top may be more comfortable. Those having a mastectomy will be given an artificial breast prosthesis known as a ‘softie’ which can be positioned under a bra.
Toiletries are, of course, essentials of any hospital stay, as are books or magazines for reading. Additionally, you may want to take in a phone or tablet to listen to music or watch movies. This is fine – as long as you are using headphones! If you are taking regular medication, this should also be brought with you – but any issues around this medication should have been discussed with your specialist team at your pre-surgical assessment.
You’ll either be admitted on the morning of your operation or the night before. Your doctor will talk to you about the procedure and get you to sign a consent form. You are free to ask questions of the doctor, so don’t be afraid to ask if there’s anything that’s making you feel uncomfortable.
If you didn’t receive a pre-assessment, the aforementioned tests would be performed now. You will be fitted with whatever garments you need and will be given several injections (pain relief, anaesthetic and anti-sickness drugs). You’ll also be visited by an anaesthetist who will discuss matters and can provide medication to help you relax before the operation.
Eventually, you’ll be taken to the anaesthetic room where a checklist will be performed to get you ready for surgery. You’ll be given the appropriate anaesthetic, as you agreed and, before you know it, you’ll drift to sleep and be taken into the theatre for the operation.
After breast cancer surgery, most people won’t experience many major side effects. Some people wake up sooner than others. When you do wake up, don’t worry if you’re connected to tubes or breathing through a mask – this is completely normal.
Once you feel comfortable after waking, you’ll be encouraged to move about and sip some water. You may feel a bit dizzy when standing up for the first time, as some blood may have been lost during the procedure, but this is also normal.
Usually, by the time of the next morning, you’ll be able to leave the hospital. However, if you’ve had surgery with breast reconstruction, you may be kept in a bit longer.
Recovery: What to expect after a breast cancer surgery
After you’re home, you may still be feeling some side effects from the operation. You may feel pain, discomfort, swelling, sore and bruised or even nauseated.
You may have a stiff and sore shoulder and/or arm after your surgery – often you’ll be given exercises by your nurse to help deal with these pains). You may feel changes in sensations (such as burning or pins and needles) or notice scars.
Other side effects can include:
- Discolouration of skin around the sentinel lymph node and urine (if you had a sentinel node biopsy with the use of blue dye, this is normal and lasts a few days as it is flushed from your system)
- Cording (a tight area of skin tissue that can restrict arm movement. Stretching can help, but you may need to see a physiotherapist)
- Lymphoedema (swelling of the arm, chest/breast or hand caused by a fluid build-up on surface tissues)
If you have any concerns about side effects, then talk to your GP or contact the specialist team.
You may also find that you experience psychological issues that are linked to the stress and changes that can occur as a result of breast cancer surgery. You may note changes to your body, or you may feel a sense of loss. It may even affect your self-confidence and how you feel about yourself. Many women report feeling ‘unfeminine’ or ‘incomplete’ as a result of the surgery.
If you have just had breast cancer surgery and feel like this, it’s important to remember that you are not alone and that there are support charities that can help. Thousands of people, particularly women, go through this procedure every year – and many thousands more have gone on to enjoy life again. It’s thought that there are nearly 2.5 million people who have, or had, cancer living in the UK. As breast cancer is the most common cancer in the UK and has an incredibly favourable survival rate when compared to many other cancers, that means that there are many hundreds of thousands of women out there who have had a similar experience to you.
Support groups for those living with breast cancer, or those who have gone through the breast cancer surgical process, can be found in many local areas across the UK. Additionally, support from close loved ones – such as a spouse, friend or family member – can help you get through this.
The process of getting accustomed to any changes in your body and dealing with any of the physical or emotional side effects, can also be aided through employing a short-term carer. There are carers who specialise in helping women with breast cancer in their post-operative recovery around the home and can offer a sympathetic ear to what you are going through.
Better Healthcare’s carers are here to help
This can be especially helpful to many women who are feeling uncomfortable talking about their concerns immediately after surgery when both physical pain and feelings can be particularly raw. Our friendly carers will ensure you are eating healthily, doing the necessary exercises to stay fit and are great listeners if you ever feel like talking.
This can be especially helpful to people with limited mobility to help them around the house as they adjust, older people and/or people who would appreciate the company of another person to start them off on the road to recovery.
Whatever the case, age or gender, Better Healthcare’s team of friendly, qualified home and live-in carers are here to help support you as you get back to feeling your best self. Our services can be tailored to your specific requirements – ensuring that you receive the type of support you want when you want it.
To find out more about how we can help you on your road to recovery after surgery, simply give us a call on 0800 668 1234 or get in touch with one of our local offices today.
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This post is not health advice and should not replace professional advice tailored to your specific circumstances. It is intended to provide information of general interest about current healthcare issues.