Receiving a breast cancer diagnosis can be incredibly upsetting, leading to anxiety both for yourself and loved ones as to how to proceed. Mr Kenny will firstly get to know you as a person, before guiding you through each step in your journey with clear instruction, explaining the rationale behind each decision along the way. Once a treatment plan has been formally agreed, he can provide the following surgical options where suitable.
Breast conserving surgery
Wide local excision – For small, screen-detected areas of malignancy or cancers within larger breasts, a breast conserving approach has become the standard of care. This involves removal of the affected area with a rim of normal healthy tissue to reduce the chance of recurrence. Often for small, non-palpable areas this involves an image-guided strategy and Mr Kenny will discuss this in greater detail when appropriate.
For larger areas of disease whereby the breast remains conservable, it may be appropriate to offer more advanced oncoplastic procedures in order to replace the volume being removed, or construct a smaller yet appropriately shaped breast. These procedures include:
Pedicled perforator flap surgery – This involves a longer scar, extending from the lower crease of the breast along the lateral edge, and often toward the back. Scars are sited within the bra-line where possible, with the aim to move tissue from either the back or upper abdomen, into the breast to ‘fill-in’ the cavity created by removing the cancer. This can also be performed in a delayed setting to help with volume defects after surgery.
Therapeutic mammoplasty – This involves a ‘breast reduction’ approach whereby the skin envelope and breast tissue are reduced (to include the diseased area within the breast) and the nipple-areola complex re-sited onto a smaller, appropriately shaped breast. At a later stage following completion of any other treatment that may be required, the opposite breast can be reduced in a similar fashion for symmetry.
Lipomodelling – Following breast conserving surgery, occasionally there are areas within the breast that may appear less full, or with a ‘divot’ where surgery has taken place. This can often be corrected with either a single or multiple session of fat-grafting to fill in the affected area, which involves liposuction from a donor site (often the abdomen or outer thigh region), washing/filtering of the harvested fat and infiltration to the affected area. A degree of resorption of the fat subsequently occurs which may require further sessions for the desired final result.
Mastectomy with or without reconstruction
In some cases, or by patient choice, it may be appropriate to remove all the breast tissue. This may involve removal of the nipple-areola complex and overlying skin, however in many cases, skin and nipple preserving techniques can be utilised for improved aesthetic results, and Mr Kenny will discuss with you in further detail what options are available to you based on your particular circumstances. This may be combined with autologous reconstruction options performed in conjunction with plastic surgeons and this option will be discussed in detail in appropriate cases.
Risk reducing surgery for women at high risk
Certain genetic variants may predispose women to a high risk of breast cancer in their lifetime and in such women, risk-reducing surgery is a viable and recognised option. Mr Kenny can guide women through this process, often involving specialist psychological support to ensure women are empowered to make the correct decision for them.
Frequently Asked Questions
How do I know which treatment option is best suited to me?
Mr Kenny will firstly guide you through your diagnosis, explaining the implications of current findings and also what has been recommended by the breast cancer multidisciplinary team. When ready to proceed with a surgical strategy, Mr Kenny will re-examine you and outline which treatment he would recommend, and why. In truth, there are often multiple approaches that can be taken, and Mr Kenny will take the time to explain each one carefully, their implications and limitations, such that a shared decision can be made as to how best to proceed.
What is the breast Multidisciplinary team (MDT)?
All confirmed breast cancer cases in the UK should be discussed at a multidisciplinary team meeting consisting of breast cancer surgeons, radiologists (imaging doctors), oncologists (cancer specialists) and pathologists whom analyse the specimens under the microscope. It is supported by breast cancer nurse specialists and administrative staff, with the aim of promoting shared decision making to ensure all cancer patients receive optimal care.
What is the typical recovery time after breast cancer surgery?
This varies depending on the type of surgery and underlying medical background but typically patients are up and on their feet the day after surgery. A return to light duties may occur after 2 weeks and return to normal activities including gym/sports within 6 weeks. The incisions will be covered with a waterproof dressing for 10 days after surgery, and showering can occur throughout this period. Avoid soaking the wound in a bath, pool or sea for 6 weeks after surgery. Patients are encouraged to discuss with their insurer as to when to return to driving.
Are breast implants safe to use in my reconstruction?
Mr Kenny uses MENTOR® Breast Implants as standard although alternative manufacturers may be possible on request.
I’m concerned about my family history of breast cancer. What should I do?
Mr Kenny will take an in-depth history regarding both your own personal cancer history and that of your extended families. It helps to acquire as much information as possible prior to attending your appointment, notably ages and diagnoses, so that a complete family picture can be determined for up to two generations. Where appropriate, Mr Kenny can organise for genetic testing to be carried out, or determine a surveillance programme in line with your wishes. If a high-risk genetic variant is identified, Mr Kenny can discuss with you all options available, including chemoprevention, enhanced surveillance or risk-reducing procedures.