Breast Care Surgery

As part of its commitment to breast care, the London Bridge Hospital carries out a wide range of breast surgery procedures including breast ultrasounds, mammograms and breast cancer treatments. With an experienced team of consultant surgeons, radiologists, pathologists, oncologists and specialist breast care nurses we can provide a multidisciplinary approach to all breast care.

Anyone attending the hospital with signs of possible breast problems will receive a rapid assessment. Where required, diagnostic tests will be carried out during the first visit and patients will receive a diagnosis within three days. A specialist breast nurse is present during all outpatient clinics and during any inpatient stay.

Our Specialist Breast Care Nurses are offering a oncology support group. Please do not hesitate to contact Gill Welch on 020 7234 2502 for further details.

The following list gives an outline of breast care procedures available at the London Bridge Hospital. For a more detailed discussion of what is involved in each procedure you should contact the relevant specialist.

Breast Ultrasound

A scan of the breast tissue using a hand held probe emitting high frequency sound waves, similar to that carried out during pregnancy. Clear gel is used to enhance the contact between the probe and the skin. A breast ultrasound does not replace the need for a mammogram, although it may be used to further investigate a problem seen on a mammogram.

Core Needle Biopsy

A breast biopsy carried out using a special needle that removes a small slither of breast tissue to check for, among other things, breast cancer. A core needle biopsy is usually carried out along with an ultrasound to improve accuracy and a local anaesthetic to ensures that most women do not feel anything at all. There is, however, often some bruising after the procedure. The analysis of the tissue obtained takes around 48 hours. It is sometimes possible to provide a much faster provisional result from a core needle biopsy by taking individual cells from the surface of the tissue (core imprint).

Fine needle aspirate cytology (FNAC)

A breast biopsy carried out using a very thin needle, FNAC feels similar to having a blood test and is performed along with an ultrasound to improve accuracy. The needle detaches small clusters of breast cells which are then placed on a glass slide and examined under a microscope for signs of breast cancer. Results are available within 45-60 minutes.

Mammogram

A breast x-ray, usually performed on both breasts so that a comparison can be made. The mammogram machine gently compresses your breast before the x-ray is taken. Each breast is x-rayed from two directions, making four x-rays in all. We usually do not carry out mammograms on women under 35.

Stereotactic core needle biopsy

A core needle biopsy (see above) carried out under mammogram control as opposed to the more normal ultrasound control. This procedure is only necessary in cases where the abnormality to be biopsied is not visible on ultrasound.
Axillary node clearance.

The surgical removal of lymph glands under the arms that have been affected by breast cancer. This important part of the treatment to reduce the risk of breast cancer returning also provides essential information to help decide on the need for drug treatment. The surgery is carried out through a small incision in the affected armpit (axilla). The fat containing the glands is removed. A tube is inserted to drain any fluid or blood resulting from the surgery. The tube is usually removed after 3 days.

Breast reconstruction

Reconstructive surgery that takes place after a mastectomy has been performed, commonly because of breast cancer. The procedure is sometimes performed immediately after the mastectomy and sometimes at a later date. There are several techniques in use. Some involve insertion of a silicone implant under the chest wall muscle (submascular implant), others are done by raising the skin and the muscle of the back to provide adequate cover for the implant (LD flap).  It is also possible to use the skin and the fat of the tummy (TRAM flap) or buttock (S-Gap) to reconstruct a breast. These are complicated procedures and discussing them with your surgeon is very important before you decide which one is right for you.

Correction of inverted nipple

An operation, carried out under general anaesthesia, used to correct an upturned nipple. This condition can occur as a result of the shortening of the milk ducts due to a variety of benign conditions such as chronic infection. A short cut is made at the base of the nipple and the milk ducts are divided, releasing the nipple. A couple of fine stitches are placed to close the wound.

Excision biopsy

A minor surgical procedure, carried out under local or general anaesthesia, used to ascertain the nature of a breast lump. A small cut is made over the site of the lump. The lump is then removed and a single hidden, dissolvable stitch applied. The removed tissue will then be examined for signs of breast cancer and any other possible causes.

Excision of a benign (non-cancerous) lump

A minor surgical procedure, carried out under local or general anaesthesia, used to remove a benign breast lump. A small cut is made over the site of the lump. The lump is then removed and a single hidden, dissolvable stitch applied. The tissue removed will then be examined as a matter of routine.

Fistulectomy and saucerisation

The surgical removal of infected tissue underneath the nipple. The small opening at the edge of the nipple through which the infection drains is also removed. Often the wound does not heal well due to the infection and may become re-infected. In some cases the wound is left open and allowed to heal together by itself.

Mastectomy

The surgical removal of a majority of the breast tissue. The resulting scar can vary depending on the amount of tissue and skin removed. Only in exceptional circumstances does the nipple need to be removed. The operation, often the result of breast cancer, is performed under general anaesthesia. Drains are routinely inserted to assist drainage of the fluid and blood. These stay in place for about 3-5 days.

Modified radical mastectomy

A mastectomy that involves the removal of the breast plus the removal of all the lymph nodes in the armpit. This is only necessary when there is invasive breast cancer that has spread to the lymph nodes.

Microdoductectomy

A surgical procedure, performed under either local or general anaesthesia, used to remove a discharging duct. Nipple discharge, particularly if blood stained, can be a manifestation of breast cancer, albeit rare. The operation involves making a short cut at the edge of the brown area surrounding the nipple, (the areola). The duct is then identified and removed along with a small amount of surrounding breast tissue. The tissue is then sent for microscopic examination.

Needle localisation and excision

The insertion of a fine wire into the breast to precisely locate an abnormality prior to removal. Performed under local anaesthesia in the x-ray department, the patient will be taken to theatre at a later date, and under general anaesthesia, have the whole of the abnormality removed
in a similar procedure to the excision biopsy (see above).

Sentinel node biopsy

A surgical procedure that removes lymph node tissue to look for signs of breast cancer spreading from the original cancer site. To know which gland to remove the surgeon injects a blue dye in the skin of the breast about 10minutes before operation. Through a small incision under the arm the surgeon can identify the right lymph glands by the blue colour. The removed glands will be examined under the microscope to determine if a second operation is needed to clear the rest of the glands.

Total duct excision

The surgical removal of the milk ducts. Commonly performed under general anaesthesia, this operation is used to prevent unwanted discharge from the nipple or nipples occurring. Although usually benign, it can be a socially embarrassing problem. A cut is made at the edge of the areola and all the milk ducts detached from the under surface of the nipple and surrounding tissue.

Tumourectomy/ Wide excision

The surgical removal of a cancerous lump. This procedure, usually performed under general anaesthesia, is the same as the excision of a non-cancerous lump (see above) though the surgeon is more determined to remove every trace of the growth.

Further information:
Telephone: 020 7234 2009
Fax: 020 7234 2019