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Breast Cancer in women

Breast Conserving Surgery, lumpectomy or wide local excision

This is the removal of the breast lump together with some surrounding normal tissue also known as a lumpectomy or wide local excision. It removes the least amount of breast tissue, but leaves a small scar and sometimes a small dent in the breast. For most women, the appearance of the breast after a breast conserving surgery is good (see 'Body image'). The surgeon also usually removes lymph glands from under the arm to check whether any cancer cells have spread from the breast (sampling or sentinel lymph node biopsy). This helps doctors decide whether other treatment is needed. Often radiotherapy is used after breast conserving surgery to increase the chances of beating the cancer, which has meant that breast conserving surgery with radiotherapy is just as effective as having a mastectomy (total breast removal). Some women may also have chemotherapy before surgery (neoadjuvant treatment) to help shrink the cancer ready for breast conserving surgery.

Before the operation an ultrasound scan is taken under the arm (axilla) to see if the lymph nodes look clear of cancer. If it is suspected that there are cancer cells in the lymph nodes a biopsy or fine needle aspiration is done and sent to the laboratory for checking. In most cases where the ultrasound scan or the biopsy shows cancer cells the surgeon may want to remove all the lymph nodes in the armpit. This is called an axillary lymph node dissection (ALND) and is done at the same time as the breast conserving surgery. An ALND may also be done in a second operation if sampling or the sentinel lymph node biopsy in the original operation shows there are cancer cells in the lymph nodes. Whether to do a full ALND or just use radiotherapy after surgery if cancer is found in the lymph nodes is an area of clinical uncertainty and needs more investigation. It may also depend on the number of lymph nodes affected.

Sentinel lymph node biopsy is another way of checking just one or two of the lymph glands to see if they contain cancer. This would normally be done if the ultrasound scan and initial tests had looked clear. It involves injecting a tiny amount of radioactive liquid into the area of the cancer before the operation. The lymph nodes are then scanned to see which has taken up the radioactive liquid first. A blue dye is also injected into the area of the cancer during the operation. The dye stains the lymph nodes blue. The nodes that become blue or radioactive first are known as the sentinel nodes. The surgeon removes only the sentinel nodes so that they can be tested to see whether they contain cancer cells. Sentinel node biopsy reduces the chances of side effects such as arm stiffness and swelling (lymphoedema) of the arm that can occur after sampling or ALND. It can also cause less pain and does not need a drain into the wound afterwards. In some hospitals, the surgeon can get the laboratory to check for cancer in the lymph nodes while the patient is still under anaesthetic the surgeon can then continue to remove all the other nodes if necessary and avoid a second operation.

Most women who have breast conserving surgery are able to have their surgery either as a day case or with a short overnight stay. Here women discuss their experiences of having breast conserving surgery and the hospital environment.

Some women discussed the fears they had before having the operation. One woman prepared herself psychologically for the surgery, while another prepared herself physically by becoming as fit as possible.

 

Describes her feelings before and immediately after the operation.

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Describes her feelings before and immediately after the operation.

Age at interview: 75
Sex: Female
Age at diagnosis: 68
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I'd never been in hospital before so it was quite strange to me. And they asked me what I'd like to be called and I said' "Well, [name] you know and so on. They put that on the door. And the nurses were very nice and kind and they came and told me and the consultant came, told me what would happen.

And the, on the morning of the operation I had a little sort of, kind of sleeping pill or something to make me relaxed I think. And then I went down on the trolley and they gave me a little injection.

And the next thing, I was a bit worried having never had an operation, never been in a hospital before. But they were all very you know comforting and so on, told me what would happen, that I would just doze off and everything. Well the next thing I heard was' "Are you ready to go back to the ward now?" And I was so surprised, you know.

I mean people who have operations probably know that you just pass out and that's the next thing you hear, but I was so staggered you know. I thought my goodness, you know. But there it was and then I was up in my room and I was really quite fit you know. I was sort of compus mentis and thought that you know I'd be pretty shaken and everything but I was alright actually.
 
 

Describes how she prepared herself physically for the surgery and how it helped to feel she was...

Describes how she prepared herself physically for the surgery and how it helped to feel she was...

Age at interview: 56
Sex: Female
Age at diagnosis: 54
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Yes, at the integrated medical centre they have, you can have infusions -that's like a bag of, a cocktail of things, there was a lot of vitamin C in that and all the other nutrients - and it's specially put together depending on your personal need. You see the doctor. They are GPs but who have then gone on to specialise in integrated nutritional support.

And there are a lot of men of science who challenge this but more and more they're having to eat their words, if you'll excuse the pun.

And I had two or three of these. They take a long, they just put a needle in your arm and it drips in over a couple of hours and you sit there with two or three others who are going through the same procedure. And you drink lots of water. And my God you feel bouncy afterwards.

And for the next couple of weeks, it gives you the strength to - I believed it did, I certainly felt that. It may be psychosomatic but I felt that I, I was doing something. And I was believing in what I was doing, and I know that's half the battle.

But nutrients and infusions of nutrients are not going to harm you and they may just be all the difference between, you know, making you ready for surgery, fighting against infection.

That's how it was.
 

Some women described parts of the surgery procedure, and most said they found the operation painless and straightforward. However, a few women had complications during or after surgery, such as infections. For one of these women, her hospital experience was made worse by language difficulties.

 

Describes her experience of having a lumpectomy.

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Describes her experience of having a lumpectomy.

Age at interview: 63
Sex: Female
Age at diagnosis: 58
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Well you go into hospital and of course you have all the usual check-ups beforehand and then they take you up to the theatre. They give you something to relax you first, take you up to the theatre and operate.

The surgeon comes round first and tells you what's going to happen and what they're going to do, and why they're not giving you a mastectomy and why they're doing this.

Because that's, they give you conservation surgery now instead of, so you've still got something there. Even though it's a different shape but you can be built up if you want to. But I never was, didn't matter that much to me, I'm not that young anyway.

But then you go up to surgery and of course then you don't really know anything until you come out. And I come out of surgery and I was in a lot of pain.

Did you have a drain and things like that?

Yes, you had a drain.You walk around with a drain all the time until it clears. Yeah, a bag, yeah.

And stitches, did you have?

No. I didn't have stitches no, no just the drain. Well I, no that's a lie, that's a lie. Of course I had stitches because I had stitches where I had the surgery. And they took the lymph glands away and I had stitches under my arm.

But she was an absolutely marvellous surgeon because you can't hardly see anything.
 
 

Patient from West Africa describes her difficulties in communicating with hospital staff about...

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Patient from West Africa describes her difficulties in communicating with hospital staff about...

Age at interview: 38
Sex: Female
Age at diagnosis: 37
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So in the hospital I saw many things.

I know that I don't know English and when the doctor come he can't communicate with me. He can't speak to me, he can't ask me if I have pain.

Even the women who were working there, they can't ask me' "How is your pain?"

And my neighbour who was there who was sick like me, they give medicine to her. They give medicine, injection to her, and I'm there.

When morning my sister came and they speak to my sister, I was very surprised because I said' "Why? The same disease this woman has, they give medicine to her and they didn't give anything to me." So I was depressed in this hospital. I didn't speak, because I can't speak. What can I say to the doctor who want to, they told me two days, three days, they didn't give anything to me.

And they told me' "You have to go home because we don't have place here."

In this time my breast, the wound they did, it was open again. They didn't take the time to close it, and they told me to go home. I went home and when I went home it was very open, so I was crying. And it was infected.

When I came back in hospital to tell the nurse, who was in hospital, about my breast they said' "It's not infected." Because oh, you know, water was coming out.

So I cry, cry. And I went to see my GP because he is from France, I can speak French with him. And when I went to see my GP, oh he was, he was surprised.

He give medicine to me, antibiotic, and one woman who is the nurse in this hospital, where my GP is, this woman is very good. She helped me. She told my GP to give medicine to me and she told me to come every day to do the, what do you call it, to put medicine on my breast.
 

Some women found having the lymph nodes tested and waiting for results more worrying than the lumpectomy itself. Most said that test results were given by medical staff sensitively, though one woman was dissatisfied by the way news had been communicated.

 

Comments that having the lymph nodes removed and waiting to learn if they had been affected was...

Comments that having the lymph nodes removed and waiting to learn if they had been affected was...

Age at interview: 66
Sex: Female
Age at diagnosis: 64
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So they took the lymph nodes out, and that, I mean - taking the actual tumour out - okay so you have a general anaesthetic, so it makes you feel awful but apart from that there wasn't really anything to that.

But in actual fact this taking the lymph nodes out is very, very - afterwards, it's extremely uncomfortable and quite painful. But I think I had painkillers once that's all.

Anyway, so he did that and I stayed in hospital three or four days then and came home. I went back again on the following Monday and he said' "It wasn't in your lymph nodes." He said he took 22 and he said the pathologist can't look at every one.

And then he explained that the lymph nodes, we all know this as well, is in a triangle. And he said if it's not in the bottom lymph nodes, it won't be in the top ones because they know it travels like that, and that's the way the lymph nodes are.

So, I was highly relieved. So, it wasn't in the vascular system, it wasn't in the lymph nodes. And of course when he told me that I burst into tears with relief.
 

Some woman had a lumpectomy followed by a partial reconstruction. One woman, who was diagnosed with breast cancer during pregnancy, had a lumpectomy three weeks after a caesarean.

 

Explains that she had a lumpectomy followed by a partial reconstruction.

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Explains that she had a lumpectomy followed by a partial reconstruction.

Age at interview: 34
Sex: Female
Age at diagnosis: 34
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He said that he would be doing the surgery and what happens with the mini-flap operation is that it needs two operations.

So you'd have one - his usual operating times were Tuesday and Thursday but he would need to book me a special slot on the Monday in order to make the anaesthetist happy about putting me under for a second time.

I was in hospital all this time. So it was from the Sunday we checked in and Monday was the first operation. The Wednesday was when I found out about the lymph nodes and the Thursday was the second operation.

And I went in for the surgery and he'd explained it was a longer surgery, so it takes longer to get over. Plus the fact it's like two operations. So I came round from the second operation with two drains in.

Where exactly had they moved muscle from, or tissue from?

It's hard to explain but they'd moved, they'd swung one part of the shoulder muscle round in. So it kind of comes underneath the armpit and goes through.

I remember looking down after the surgery because as part of the surgery they ask you to keep your bra, to bring in an old bra and keep your bra on so that the breast has got support.

And I remember looking down and seeing that I still had a cleavage and I was so happy! Nothing hurt.

My shoulder was stiff and the physiotherapist came round and had exercises for me to do and I did them, and I can move my arm fine now.

It's not a problem at all.

 

Explains that she had a lumpectomy three weeks after a caesarean birth.

Explains that she had a lumpectomy three weeks after a caesarean birth.

Age at interview: 34
Sex: Female
Age at diagnosis: 30
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I had a lumpectomy, two weeks after I had [my son], I had a caesarean on 26th June and it was almost three weeks after actually that I had the lumpectomy, it was on 14th July.

Then they wanted again for me to recover from that before I started my chemotherapy and I started that in October 1997.

I managed to give him his first breast feed as well.

Although after that they gave me bromocriptine to dry the breast milk out, which is a drug that dries the milk out, because obviously they wanted the milk to dry out so that in the future they could operate on the breast.

And obviously having had a caesarean I needed to be over that before I had this further operation.

One woman, who was interviewed 2 weeks after receiving her diagnosis of cancer, was awaiting surgery.

Some women praised the care they had received from doctors and nurses. One woman, however, was disappointed with her treatment and with hospital staff.

 

One woman who had a lumpectomy as a day patient criticises the treatment she received in hospital.

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One woman who had a lumpectomy as a day patient criticises the treatment she received in hospital.

Age at interview: 40
Sex: Female
Age at diagnosis: 38
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I went for the operation, which was supposed to be under local anaesthetic. I went with my friend and my daughter on the eleventh. They went to the museum while I'm going in.

But just as they were pushing me into the theatre I was told that it's going to be on general anaesthetic.

I refused and then was told then I would be again on the waiting list, and knowing the waiting lists in this country I thought' "Okay, I trust you with my life." I went in and they pushed me out at four o'clock, at four-thirty I was discharged.

And I was just given pain killers, no instructions what to do if complications come. I went straight to bed. Ten o'clock at night I woke up with a terrible pain and my breast swollen twice its original size.

She called the hospital they said yeah we have to go to Accident and Emergency. We went there, we arrived there at 12 o'clock, we sit there until five o'clock in the morning and when the doctor came to see me she just, she didn't even look at my breast.

She listened to what I was telling her and she prescribed the same painkillers because I took the painkillers and the letter. She didn't even open the letter which I was given for my GP which I thought in that case she was supposed to open.
 

Many women discussed the post-operation check-ups they had, and several said they felt lost or unsupported when follow-up care ended. Women also talked about the friendships they had developed with other patients, which had often continued after leaving the hospital.

 

Comments on feeling unsupported following the end of treatment.

Comments on feeling unsupported following the end of treatment.

Age at interview: 51
Sex: Female
Age at diagnosis: 48
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In fact the other thing I think that, once you've finished your treatment you're just left. Okay, so you've got a breast care nurse you can contact if you want to, but she's busy, she's got other more important things to do.

You just feel as though, that you're just dumped basically, you know? 

"That's it. Treatment's over. Finished, done with. Off you go. See you in four months." And it's a bit scary. Especially when you've got things like' "Oh God, that pain," you know? "Is that normal?"

And things like that. I think they could do with some, I know the NHS is stretched but I really think they could do with somebody you could call on should you need to. 

I guess that's what support groups are for.
 
 

Comments on the support given by hospital staff and how friendships developed with other patients.

Comments on the support given by hospital staff and how friendships developed with other patients.

Age at interview: 56
Sex: Female
Age at diagnosis: 53
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The ward was wonderful. It was a ward that was especially allocated to people with the same problem.

A number of the patients in the ward had pre-cancerous cells and they came in on the Monday early, starving, had the op and went out the next day.

But there was a small group of us, I think there were six, one lady kept very much to herself but five of us kept, became very close friends and we have kept in touch since.

Everybody in the ward was just wonderful, the nurses and the staff they were supportive and kind and they encouraged us to become friends and to look after one another.


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Last reviewed August 2018.

Last updated May 2015.

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