Breast surgery at Bolton NHS FT

Breast surgery is delivered at Royal Bolton Hospital by a team of six surgeons who offer the full range of surgical techniques for investigating and treating breast cancer. We also work closely with the Plastic Surgeons at Wythenshawe hospital. The suitable surgical options will be fully discussed with you and you will be supported by your Surgeon and Breast Care Nurse, in making a decision that is best suited to you. Every patient with a diagnosis of breast cancer will receive an individualised treatment plan.

The operations that might be discussed with you include:

·         Duct excision – where a sample of the ducts from behind the nipple are removed for diagnosis

·         Wide local excision – also called a Lumpectomy. Where the cancer or pre-cancerous changes in the breast are removed with a surrounding cuff of breast tissue. If the area of abnormal tissue cannot be felt, the area needs to be marked so that your surgeon can find it at the time of surgery. This is done either using a Magseed (which is put in under local anaesthetic a few days before your operation) or a wire (which is put in under local anaesthetic on the day of your operation).

·         Excision biopsy – Most of the time, your team can make a full diagnosis of any breast disease using needle biopsies. Sometimes it is necessary to have an operation under general anaesthetic to remove a breast lump to find out exactly what the diagnosis is.

·         Therapeutic mammaplasty – where a breast reduction technique is used to remove a breast cancer and re-shape the breast. A reduction to the other breast can be performed at the same operation so that the breast volume matches.

·         Mastectomy – where all of the breast tissue is removed and the chest wall is made flat. The option of a reconstruction either at the same time as this operation, or as a separate operation in the future, will be discussed with you. If you wish to wear one, a ‘softie’ prosthesis is given to you and can be worn immediately after a mastectomy. Once your wounds are well healed, you are offered an appointment for a breast-form (prosthesis) which is a perfect fit for you.

o   Information from Breast Cancer Now about breast prostheses, bras and clothing: https://breastcancernow.org/sites/default/files/publications/pdf/bcc123_breast_prostheses_web.pdf

o   Link to Flat Friends: https://www.flatfriends.org.uk/

·         Sentinel lymph node biopsy – where a sample is taken of the first couple of draining lymph nodes from your armpit. This operation is usually performed at the same time as the surgery to remove the cancer from the breast.

·         Axillary node clearance – where all of the lymph nodes from the armpit are removed. This may be performed at the same time as the surgery to remove the cancer from the breast or as a second operation after a sentinel node biopsyPartial breast reconstruction – where a flap of tissue from just beneath, or to the side of, the breast is used to fill a space that is left by a wide local excision.

·         Breast reconstruction (THIS AS LINK TO SEPARATE PAGE)– this can be done using:

o   High-quality silicone implants with a supportive mesh (Implant-based reconstruction with acelllular dermal matrix (Royal Bolton Hospital patient information leaflet: http://intranet.boltonft.nhs.uk/Interact/Pages/Content/Document.aspx?id=7203&SearchId=0)

o   Tissue from your back (Latissimus Dorsi reconstruction) with or without a breast implant Royal Bolton Hospital Latissimus Dorsi breast reconstruction patient information leaflet (http://intranet.boltonft.nhs.uk/Interact/Pages/Content/Document.aspx?id=7204&SearchId=0)

o   Tissue from the lower abdomen (a DIEP reconstruction). This is available to Bolton patients at Wythenshawe hospital.

·          Breast reconstruction can be performed either at the same time as the mastectomy or as a separate operation, at a later date. Decisions about breast reconstruction are made carefully between you and your surgeon. You will be helped in this decision-making by your Breast Care Nurse. An appointment will be made with them to more widely discuss the options, look at patient photos and consider their suitability to you. Decision about type of reconstruction can be influenced by factors such as general health, the type of breast cancer, the potential need for chemotherapy or radiotherapy and if you are a smoker. Sometimes it may be recommended that if a reconstruction is wanted, it is performed as a delayed procedure after the cancer treatment is finished. There is no time limit after surgery for this.

The decision about whether to have breast reconstruction is an individual and personal one. Many women choose not to have any breast reconstruction.

·         Further information about mastectomy without reconstruction can be found here: https://www.flatfriends.org.uk/

o   Further information about types of breast reconstruction can be downloaded here: https://breastcancernow.org/information-support/publication/breast-reconstruction-bcc7