Procedure:
Wide Local Excision
Complete removal of the breast lump. Whilst
still under anaesthetic, the pathologist may
examine the lump to confirm that it did contain
cancer.
Some of the lymph nodes in the armpit on the
same side of the cancer will also be removed
for pathology tests for any evidence of cancer
spread.
Sentinel Lymph Node Biopsy may be an
alternative. This procedure is still considered
experimental but is widely practiced in centres
of excellence around the world. Final results
from research will take up to another five (5)
years. This alternative has found to reduce
complications :
- reduced lymphoedema risk
- reduced risk of shoulder stiffness
- reduced risk of numbness in the axilla
Sentinel lymph node biopsy may be an
alternative to routine axillary (under the arm)
dissection in selected patients. This involves:
removal of the lymph node(s) that the area of
the breast, in which the tumour lies, would drain
to first.
These are localised (pin pointed) by a nuclear
scan (lymphoscintography) and /or blue dye
(patent blue V) injection, just prior to surgery.
If the sentinel lymph node is not involved, then it
is highly unlikely that any of the other lymph
nodes in the armpit are involved and the risk of
complications from standard axillary dissection (
shoulder stiffness, armpit tenderness and
lymphoedema) are reduced.
Risks of this procedure:
There are some risks/ complications.
(a) The general risks include:
(b) Infection in the operation site causing pain,
swelling, redness and discharge and the wound
may break down. Treatment may be wound
dressings, drainage and antibiotics.
(c) The operation site under the arm continues to
ooze fluid, which collects beneath the cut. This
may need to be drained with a needle and
syringe.
(d) The layers of the wound may not heal
adequately and the wound may burst open.
This may require long term wound care with
dressings and antibiotics.
(e) The wound may not heal normally. The scar
can be thickened and red and may be painful.
This is permanent and can be disfiguring.
(f) Loss of sensation to the nipple when the
surgery is close to the nipple. This may be
permanent.
(g) Difficulty with arm movement due to shoulder
stiffness and scarring under the arm after the
operation. This is usually temporary when
treated with physiotherapy and/ or exercises.
(h) Swelling of the arm (lymphoedema) on the side
of the operation. It is usually treated with a
special type of garment, which squeezes the
arm to reduce the fluid build-up. Regular
massage is also used.
(i) Loss of sexuality due to distress at the change
in body image or depression due to the
disease. Professional counselling before and
after the surgery may help.
(j) The tumour may grow again in or around the
scar. This may need further treatment such as
surgery, chemotherapy or radiotherapy or a
combination of all three.
(k) Feelings of anxiety and depression due to the
disease and possible recurrence.
(l) Increased risk in obese people of wound
infection, chest infection, heart and lung
complications, and thrombosis.
(m) Increased risk in smokers of wound and chest
infections, heart and lung complications and
thrombosis.
Sentinel Lymph Node Biopsy:
(a) Small risk of incorrect information (ie negative
sentinel lymph node biopsy) with positive
axillary (armpit) nodes being left behind.
(b) There is a 1% or less possibility that
subsequent treatment decisions will be altered
by such information.
(c) If sentinel lymph node biopsy is positive, then it
is likely that formal axillary dissection (cutting
up of) will be required, with attendant risks of
that procedure.
(d) If sentinel lymph node biopsy is unable to be
located at the time of surgery, the axillary
dissection will be performed immediately (there
is a possibility that the technique did not work
because of malignant – cancerous – lymph
nodes).
(e) Sometimes the sentinel lymph node is an
unusual site, such as the internal mammary
nodes (between the ribs), where a further
incision may be required with temporary partial
separation of the ribs. There is a small risk of
lung injury and bleeding in this situation.
(f) Possibility of an additional incision depending
on the location of the sentinel lymph node – this
will not be known until immediately prior to the
operation.
(g) Small risk of permanent skin staining from the
blue dye used.
(h) Allergy to the blue dye.
(i) Passage of blue/green urine for a short time
after surgery (because of the blue dye used).
(j) Small radiation risk (from the nuclear study to
localise the sentinel lymph node) if pregnant.