Breast Conserving Surgery Gold Coast
Breast Conserving Surgery · Gold Coast
Breast conserving surgery removes breast cancer and some of the healthy tissue around it so that as much of your breast as possible can be kept. On the Gold Coast, Dr John Gault performs breast conserving surgery at Pindara Private Hospital in Benowa and consults at Gault Surgery in Pindara Place.
The operation may also be called a lumpectomy or wide local excision. Whether it is suitable depends on the type and stage of the cancer, where it is located, the size of the cancer compared with your breast, your imaging and pathology, and your own preferences. Breast conserving surgery is usually followed by radiotherapy. Both surgery and radiotherapy have potential benefits, limitations and risks, which are explained throughout this page.
Also called lumpectomy or wide local excision
Usually followed by radiotherapy
Margins are checked by a pathologist
Lymph nodes may be assessed at the same operation
Understanding the operation
What Is Breast Conserving Surgery?
Lumpectomy and wide local excision are other names for breast conserving surgery. The cancer is removed together with a margin of surrounding tissue, while the remainder of the breast is kept.
It is one of the two main types of breast cancer surgery used in Australia, the other being mastectomy.
Keeping the breast usually means having radiotherapy afterwards. The potential benefit is retaining the breast where this is clinically suitable. The limitations include the need for radiotherapy in most early breast cancer cases and the possibility of further surgery if the margins are not considered adequate. Surgical risks are listed under Risks and Possible Complications.
Who may be suitable
Who May Be Suitable for Breast Conserving Surgery
There is no single cut-off. The decision depends on the type and stage of the cancer, where it is located, the size of the cancer compared with the breast, previous treatment to the breast, imaging and pathology results, your general health and your own preferences.
Factors that may support breast conservation
- The cancer can be removed with an acceptable margin
- The amount of tissue removed is appropriate for the breast size
- Radiotherapy can be given afterwards if recommended
- Your imaging supports a breast-conserving approach
When mastectomy may be discussed instead
- Cancer is present in more than one area of the breast
- The cancer is large compared with the breast
- A clear margin may be difficult to achieve
- You have previously had radiotherapy to that breast
Medical treatment before surgery, such as chemotherapy or hormone therapy, can sometimes reduce the size of a cancer enough for breast conserving surgery to be reconsidered. These treatments have their own potential benefits and side effects, which should be discussed with your treating team.
Comparing your options
Breast Conserving Surgery or Mastectomy: Weighing Up Your Options
For most women with early breast cancer, Cancer Australia states that breast conserving surgery followed by radiotherapy is as effective as mastectomy for survival.
That means the discussion often centres on suitability, radiotherapy, the amount of breast tissue removed, the possibility of reconstruction or reshaping, recovery and the risks of each approach.
| At a glance | Breast conserving surgery | Mastectomy |
|---|---|---|
| What is removed | The cancer and a margin of surrounding tissue | The whole breast |
| Radiotherapy afterwards | Usually recommended for early breast cancer | Not usually needed, although it may be recommended in some situations |
| Survival in most early breast cancers | Cancer Australia states that breast conserving surgery followed by radiotherapy is as effective as mastectomy for survival in most women with early breast cancer. | |
| Typical hospital stay | Same day or overnight | Usually one to two nights |
| Breast shape | The breast is retained, although its size or shape can change | Reconstruction, going flat or a breast prosthesis can be discussed |
| Main risks | Both involve surgical risks including infection, bleeding, scarring, numbness and the possibility of further treatment. See Risks and Possible Complications. | |
Sources: Cancer Council and Cancer Australia.
Breast shape
Breast Reshaping Techniques During Surgery
When a larger amount of tissue needs to be removed, the remaining breast can sometimes be reshaped during the same operation.
Dr Gault has been a member of Breast Surgeons of Australia and New Zealand, BreastSurgANZ, since its inception in 2010.
The potential benefit is that reshaping may help manage the change in breast shape after a larger excision. The risks include infection, bleeding, altered sensation, scarring, wound-healing problems and the possibility of further surgery. Results vary from person to person.
Breast reshaping during breast conserving surgery is different from breast reconstruction after mastectomy. Where a flap reconstruction is being considered, referral to a plastic surgeon can form part of the treatment pathway.
Checking the lymph nodes
Checking the Lymph Nodes With a Sentinel Node Biopsy
Cancer cells that spread from the breast usually reach the lymph nodes in and around the armpit first.
A sentinel node biopsy removes the first node or small group of nodes that drain the breast so they can be checked for cancer cells. If the sentinel nodes are clear, more extensive lymph-node surgery may not be required.
Potential benefit
Sentinel node biopsy can provide staging information while removing fewer lymph nodes than a more extensive axillary operation.
Risks
Possible complications include pain, numbness, seroma, stiffness, infection and lymphoedema. These problems are generally more likely when more lymph nodes are removed.
Treatment after surgery
Why Radiotherapy Usually Follows Breast Conserving Surgery
Surgery removes the visible cancer and surrounding tissue. Radiotherapy is used to treat the remaining breast and reduce the risk of cancer returning in that breast.
For early breast cancer, Cancer Council states that radiotherapy is almost always recommended after breast conserving surgery.
The potential benefit is reducing the chance of the cancer returning in the treated breast. Radiotherapy can also cause side effects, including tiredness and skin changes, and requires repeated visits to a treatment centre. Your radiation oncologist will explain the expected benefits and risks for your circumstances.
Depending on the final pathology, chemotherapy, hormone therapy or other treatment may also be recommended. These treatments have separate potential benefits and side effects that should be discussed with the relevant treating doctor.
Pathology after surgery
Clear Margins and the Chance of a Second Operation
Cancer cells cannot be identified reliably by looking at the tissue during surgery, so a pathologist examines the edges of the removed specimen under a microscope.
| Margin result | What it means | What may happen next |
|---|---|---|
| Clear margin | Cancer cells are not identified at the relevant edge of the removed tissue. | The result is considered with the rest of the pathology and planned treatment. |
| Margin not considered adequate | Cancer cells are present at, or sufficiently close to, a relevant edge according to the clinical circumstances. | Further surgery to remove additional tissue, called a re-excision, or mastectomy may be discussed. |
Potential benefit of further surgery: additional tissue can be removed when the original margin is not considered adequate. Risks: another operation can involve bleeding, infection, scarring, changes to breast shape and further recovery time. Results vary from person to person.
Before you decide
Risks and Possible Complications
Every operation has risks. The side effects of breast cancer surgery, including lymph-node surgery where applicable, can include:
- Infection, bleeding or bruising
- Fluid collecting around the wound, called a seroma
- Numbness, tingling or altered sensation
- Scarring and changes to the size or shape of the breast
- The need for further surgery if the margins are not adequate
- Shoulder stiffness, cording and lymphoedema after lymph-node surgery
- Fatigue and risks related to anaesthesia
Dr Gault will explain which risks apply to the operation being considered and your health history.
After your operation
Recovery and Follow-Up Care
Most people go home the same day after breast conserving surgery, although some people spend a night in hospital.
Heavy lifting and vigorous activity are usually restricted during the early recovery period. You will be given instructions about wound care, movement, driving, work and returning to usual activities.
Recovery differs from person to person. Your medical advice at discharge should guide what you do after surgery.
Contact your treating team if advised symptoms occur
Follow the discharge instructions provided to you. Cancer Council advises contacting the treating team about symptoms such as increasing redness, wound discharge or fever.
Follow-up includes reviewing the final pathology, checking the wound and discussing further treatment. Care continues through survivorship and ongoing breast follow-up.
Body image and wellbeing
Scarring and Body Image Concerns
Breast conserving surgery leaves a scar, and the size, shape or position of the breast and nipple can change. How much change occurs depends on the location of the cancer, how much tissue is removed, breast size, healing and whether reshaping is performed.
Results vary from person to person. Scarring and changes to breast shape are part of the risks of breast conserving surgery. Cancer Council can provide information and support through 13 11 20.
Support and coordinated care
Support From Your Breast Care Team
Breast care nurse support is available as part of the Gault Surgery breast care team. Care may also involve your GP, radiologists, pathologists, radiation oncologists, medical oncologists, physiotherapists and other health professionals depending on your treatment plan.
Bringing a support person to appointments can help when there is a lot of information to remember. Cancer Council provides information and support through 13 11 20, and Breast Cancer Network Australia also provides information for people affected by breast cancer.
Costs and cover
Private Care, Costs and Public Hospital Waiting Lists
This page does not list a fixed price because the cost depends on the operation, whether lymph-node surgery or reshaping is included, the hospital, the anaesthetist, other providers and your private health insurance cover.
The Australian Government's Medical Costs Finder provides information about typical fees and out-of-pocket costs for private medical services.
| Cost area | What to check |
|---|---|
| Surgeon | Ask for written information about the fee, Medicare rebate, expected gap and what is not included. |
| Anaesthetist | The anaesthetist bills separately, so ask for their estimate as well. |
| Hospital | Check your excess, co-payment and what your policy covers at Pindara Private Hospital. |
| Health fund | Ask whether no-gap or known-gap arrangements apply to your planned services. |
Seeing Dr Gault privately does not change your place on a public hospital waiting list.
From referral to surgery
From Referral to Breast Conserving Surgery in Three Steps
Step 1
Get Your Referral
Ask your GP or another medical practitioner for a referral and arrange a consultation with Dr Gault.
Step 2
Review Your Diagnosis
Discuss the imaging, pathology, treatment options, expected benefits, limitations and risks.
Step 3
Plan Surgery and Further Treatment
If breast conserving surgery is suitable, plan the operation, lymph-node assessment where required, radiotherapy and follow-up.
Your questions answered
Frequently Asked Questions About Breast Conserving Surgery
What is breast conserving surgery?
Breast conserving surgery removes the breast cancer together with an area of surrounding tissue while keeping the remainder of the breast. It is also called lumpectomy or wide local excision.
Is breast conserving surgery as effective as mastectomy?
For most women with early breast cancer, Cancer Australia states that breast conserving surgery followed by radiotherapy is as effective as mastectomy for survival. Whether it is suitable for you depends on your diagnosis. Both operations carry risks, which are listed under Risks and Possible Complications.
Will I need radiotherapy after breast conserving surgery?
Radiotherapy is usually recommended after breast conserving surgery for early breast cancer. Its purpose is to reduce the chance of cancer returning in the treated breast. Radiotherapy can also cause side effects such as tiredness and skin changes, which your radiation oncologist will discuss with you.
What happens if my surgical margins are not clear?
If the margin is not considered adequate, further surgery to remove additional tissue may be recommended. In some circumstances a mastectomy may be discussed. Further surgery can help remove additional affected tissue but carries risks including bleeding, infection, scarring and further change to breast shape. Results vary from person to person.
Will my lymph nodes be removed?
A sentinel node biopsy may be performed when lymph-node staging is required. It removes the first draining node or nodes rather than automatically removing a larger group. Risks can include pain, numbness, seroma, stiffness, infection and lymphoedema.
How long will I stay in hospital?
Many people go home the same day after breast conserving surgery, while some stay overnight. Your own hospital stay depends on the surgery performed, your health and your recovery.
Will breast conserving surgery change the shape of my breast?
It can. The amount of change depends on how much tissue is removed, where the cancer is located, the size of the breast and healing. Reshaping may be considered in some circumstances. Risks include scarring, altered sensation, wound-healing problems and further changes to shape. Results vary from person to person.
Do I need a referral to see Dr Gault?
A referral from your GP or another medical practitioner is needed to claim the applicable Medicare rebate for your consultation.
Does seeing Dr Gault privately affect my public hospital waiting list place?
Seeing Dr Gault privately does not change your place on a public hospital waiting list.
Breast Conserving Surgery Gold Coast
Discussing Breast Conserving Surgery on the Gold Coast
A consultation gives you an opportunity to review your imaging and pathology, discuss whether breast conserving surgery may be appropriate, understand the alternatives and work through the potential benefits, limitations and risks.
Sources and further reading
- Cancer Council: surgery for breast cancer
- Cancer Australia: breast conserving surgery and mastectomy
- Cancer Council: guide to cancer care for breast cancer
- Cancer Council: radiotherapy for breast cancer
- Australian Government Medical Costs Finder
Gault Surgery, Suite 11, Pindara Place, 13 Carrara Street, Benowa QLD 4217. This page provides general information only and does not replace individual medical advice. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.