You have a very small cancer in the breast, or there is something in your breast that may be one. The plan is to take out the diseased part of the breast with a clear rim of healthy breast. At the same time glands will be taken from your armpit (axilla). The glands are small clusters of cells that are connected to tiny draining pipes in the breast and axilla, called lymphatics.
When cancer ‘travels’ and spreads through the lymphatics, the glands will be affected and will get bigger. This is what is meant by a wide excision and axillary sample. Sometimes all the glands are taken from your armpit. This is called an axillary clearance.
The two pieces of tissue are looked at under the microscope in the laboratory to see if the lesion in your breast is cancer or not and also to see if the cancer has spread to the glands of your axilla. Future treatment will be based on this important information.
Operation of Breast - wide excision and axillary sample
You will have a general anaesthetic and be completely asleep.
A cut is made in the skin of the breast over the swelling. Sometimes a piece of skin is taken out as well. The swelling or problem area in the breast with a rim of breast tissue is taken out.
Often glands can be taken from the armpit through this cut. If the first cut is too far from the armpit, a second cut will be needed. The breast may end up a little smaller. The operation takes about 45 minutes.
Usually there is a fine plastic drainage tube in the wound. The drain comes out through the skin usually in the skin fold under the breast. This is to drain any residual blood or other fluid from the area of the operation. The skin is closed with stitches or steri-strips (paper tape).
The tissue is sent to the laboratory to be looked at under a microscope to find out what is going on. It takes about one week to get an answer.
You may well be able to have the operation on the day you come in, and go home the same day. You may need to stay in for a day or two, if you’re still affected by the anaesthetic, the swelling is large, you are over 50, have other illnesses, or if you cannot manage at home.
If you do nothing, the problem in the breast will get steadily worse
If you know that you have problems with your blood pressure, your heart, or your lungs, asks your family doctor to check that these are under control.
Check the hospital's advice about taking the Pill or hormone replacement therapy (HRT).
Check you have a relative or friend who can come with you to the hospital, take you home, and look after you for the first week after the operation.
Bring all your tablets and medicines with you to the hospital. On the ward, you will be checked for past illnesses and will have special tests to make sure that you are well prepared and that you can have the operation as safely as possible.
You will have the operation explained to you and will be asked to fill in an operation consent form. Before you sign the consent form, make sure that you fully understand all the information that was given to you regarding your health problems, the possible and proposed treatments and any potential risks. Feel free to ask more questions if things are not entirely clear.
Any tissues that are removed during the operation will be sent for tests to help plan the appropriate treatment. Any remaining tissue that is left over after the tests will be discarded.
Before the operation and as part of the consent process, you may be asked to give permission for any ’left over’ pieces to be used for medical research that has been approved by the hospital. It is entirely up to you to allow this or not.
Many hospitals now run special preadmission clinics, where you visit for an hour or two, a week or so before the operation for these checks.
Alternatively, you may have a fine tube in your back through which pain relief can be given to help control the pain. A general anaesthetic will make you slow, clumsy and forgetful for about 24 hours. The nurses will help you with everything you need until you are able to do things for yourself. Do not make important decisions, drive a car, use machinery, or even boil a kettle during this time.
The drain will be removed when it drains only a very small amount of fluid. This can take anything from a few days to two weeks. You may be given a blood-thinning injection in your skin once a day to prevent any blood clots in your legs. This can happen in the first few days after the operation until you can move around a bit more. Those clots can be very dangerous because they can ‘travel north’ through your blood stream to your heart and lungs and cause very serious problems and even death.
The wound may be closed with stitches, or paper strips, which need to be taken out by the nurses about a week after the operation. Sometimes there are stitches under the skin instead. These melt away, so that the wound does not need any more attention.
You can wash, bathe, or shower as soon as you go home but try to keep the wound area dry until the stitches, or paper strips are taken off. If the stitches are only under the skin keep the wound area dry for a week. Soap and tap water are quite all right. Salted water is not needed.
The hospitals will arrange a check-up about a week after you leave hospital to give you the results. The nurses will advise about sick notes, certificates etc.
You can drive as soon as you can make an emergency stop without discomfort in the wound, i.e. after about three to four days. You should be able to return to a light job after about three or four days and any heavy job within two weeks.
It is not unusual after an operation like this to experience some psychological problems. Some studies show that almost up to 40 per cent of women who have had this operation can feel depressed, anxious or have sexual difficulties.
The hospital has well organized counseling services (including discussions with patients who had a similar experience to yours) that can support and help you before and after the operation. This is very effective most of the time.
The tests that you will have before the operation will make sure that you can have the operation in the safest possible way and will bring the risk for such complications very close to zero.
Complications are relatively rare and seldom serious.
In the first 24 hours, look out for any bleeding coming through the dressings. This will usually settle by applying some pressure on the wound. Although unlikely, you may need another operation to fix the problem.
Bruising and swelling may be troublesome, particularly if the wound was large. The wound swelling may take four to six weeks to settle down. There is up to a 20 per cent chance that you will develop a seroma after this operation. This is a collection of clear fluid under the wound. The risk increases according to how extensive the operation was and the number of glands removed.
If it happens, you will need regular evacuations (aspirations) of the fluid using a needle which is passed through the skin into the collection of fluid. This continues until there is no more fluid under the skin, If the fluid collection is large then after numbing the skin area on top of the collection with an anaesthetic injection, a fine plastic tube is placed through your skin into the collection to drain the fluid. The tube will remain in place until no more fluid comes out. In the meantime, you will be given antibiotics to make sure that the seroma does not get infected.
Overall the chance of infection after this operation is 1 to 3 per cent and settles down with antibiotics tablets in a week or two. If a seroma is present and is not treated promptly, the chance of infection can be two to three times higher. An infection can be serious and you will need to have it treated with intravenous (through a vein in your arm) antibiotics.