Breast diseases are very common. These can range from benign (non-cancerous) lumps through to advanced breast cancer. Breast cancer is one of the most commonly occurring cancers in new Zealand. Mr Patel treats breast cancer almost every day in both his public and private practices.
Mr Patel undertook specialist breast disease training in Australia, at the prestigious, Royal Melbourne Hospital Breast unit and Royal Woman’s Hospital Breast unit. In both these units he sub-specialised in the following:
- Breast cancer management and surgery
- Oncoplastic Breast Cancer surgery
- Benign breast disease
- Breast tenderness
- Breast lumps
- Breast cysts and fibroadenomas
- Breast cancer Family History Risk Assessment (working closely with the Genetics unit at Auckland Hospital)
Mr Patel presents and discusses all his cancer patients at the Whangarei Hospital breast Multi-disciplinary Meeting. This meeting is attended by other specialist breast surgeons, breast radiologists, breast oncologists and specialist breast nurses. In this way, he ensures all his patients receive the best up-to-date care possible.
This is important because not all breast cancers are the same, and individual treatments can vary significantly for specific cancers. You can be assured that your cancer treatment plan is concordant with international guidelines and best practices.
At your initial breast disease assessment, Mr Patel will make detailed enquiries about your current concerns, take a thorough breast specific history and perform a comprehensive breast examination at his private consulting rooms. He then spends sufficient time discussing the best and safest management plan for you. This will include investigations (usually a breast ultrasound and mammogram), followed by a possible biopsy of any breast lesions and also the need for any potential surgery.
Mr Patel will always keep his patients up-to-date with the most current and relevant treatment, including surgery, radiation treatment and chemotherapy options. This is in conjunction with his radiation and oncology colleagues. Breast cancer treatment is very bespoke.
Breast Surgical options
Mastectomy involves the surgical excision of the entire breast. An ellipse of skin is excised with the breast. The skin closure is a straight line across the chest with the skin over the pectoralis muscle. Commonly, dissolvable sutures will be used. This surgery is performed under a general anaesthetic and usually requires two nights inpatient stay in hospital. Having a mastectomy means that you are very unlikely to be recommended radiation treatment after the surgery. There will be at least one drain temporarily attached under the skin in the armpit. You might be discharged with this drain attached and with district nurse input on the management of the drain. Most patients need between 3-4 weeks recovery after a mastectomy. For the first 1-2 weeks after surgery, this means being at home (off work), relaxing, and not doing any physical activity, apart from light low-impact walking on the flat. During weeks 3-4, depending on your occupation, the amount of physical activity can slowly increase. The main symptom most patients encounter is lethargy – being tired easily. This is normal after any surgery. Mr Patel will discuss this with you in more detail post surgery.
WIDE LOCAL EXCISION (WLE/lumpectomy / partial mastectomy)
This surgical procedure involves removing only part of the breast that has the breast cancer. The remainder of the breast is not surgically removed. The remaining breast is carefully repositioned to fill the space that has been left by the removal of the cancer. In this way, almost all women who undergo this procedure will have relatively normal cosmetic appearance of their breast. There will still be a scar however, and the breast might be slightly smaller then its pre-operative size. When cancers greater than 3cm are removed, a small ‘indent’ may be present where the cancer was. For most women there will be no indent. When a woman undergoes this surgical procedure, radiation to the breast is almost always recommended. The function of the radiation is to decrease the chance of local recurrence of the breast cancer. The main risks to this procedure are bleeding, infection and cosmetic change. These risks are very small, and occur in 1-5% of women. There is also a small risk of the need for further surgery to the breast. This would only occur if the final size of the cancer is much larger than expected, and the margins are positive for cancer. Most patients will spend between 1-2 nights in hospital post surgery. Recovery usually takes 2-4 weeks. Most patients will only require 2 weeks of recovery at home. Depending on how physically demanding their employment is, they may then return to work.
Sometimes, the breast cancer can be quite small. These will require a radiologically placed hookwire to assist Mr Patel in locating the breast cancer. This is placed on the day of surgery. Mr Patel will discuss this procedure in detail when he sees you.
SENTINAL LYMPH NODE BIOPSY (SNB)
SNB involves removing a lymph node for testing to see if there is cancer within it. There are usually between 1-3 nodes that are removed from the armpit (axilla) for testing. This surgical procedure will occur at the same time as the breast surgery, during the same general anaesthetic. There are approximately 15-20 lymph nodes in the axilla, and the main function of these lymph nodes is to help with removing infection. We know that when breast cancer spreads, the first place it spreads is to the lymph nodes in the armpit. Hence the testing of lymph nodes. The sentinel lymph node is the closest lymph node to the breast cancer, and this is the one that is removed. Sometimes more than one need to be removed. During the surgery, this lymph node is tested by a pathologist to determine if it has cancer. The testing process usually takes 20-40 minutes. If the lymph node is positive for cancer, Mr Patel will then proceed with an axillary lymph node dissection. The main risks from an SNB are bleeding and infection. Some women complain of discomfort that lasts for a few months after the surgery.
AXILLARY LYMPH NODE DISSECTION (ALND)
An ALND is a surgical procedure involving the removal of a specific group of lymph nodes. If an SNB is positive for cancer, Mr Patel will proceed, during the same general anesthetic with an ALND. When the SNB is positive for cancer, there is a chance that the other draining lymph nodes could also have cancer in them – resulting in the need to surgically remove them.
The main risks with this procedure are bleeding, infection, and sensory nerve damage. The risk of sensory nerve damage is almost 100%. This means you will have a ‘numb’ area of skin under the armpit. Motor (movement) nerve damage may also occur, but this is very very unlikely. Mr Patel has done hundreds of these procedures without resulting in any damaged motor nerves.
There is also a risk of lymphoedema. If it occurs, it will usually present between 1-3 months after the surgery. A drain is routinely placed under the axilla skin to drain fluid. This drain will remain in the skin for 3 to 7 days. Usually the drain is removed in less than 5 days. Most women will require between 3-4 weeks to recover enough to return to their jobs. However, this is patient specific.
HOOKWIRE EXCISION BIOPSY
This surgical procedure is very similar to a WLE, however the area that is to be removed is much smaller. This is usually done when the initial core biopsy does not yield enough information to determine if there is a cancer present. In this situation a surgical excision, usually wire guided, is needed to obtain more breast tissue to help the pathologists determine if cancer is present. This is a usually a day procedure.