Breast Cancer
Breast Cancer Treatment
At the Hampshire Breast Clinic, our specialist breast care nurses are dedicated to supporting you at every stage throughout your breast cancer treatment. Preparing for breast surgery and undergoing treatment can feel overwhelming, which is why our goal is to ensure you are fully informed, reassured and supported from diagnosis, treatment and recovery. On diagnosis you will be provided with a telephone number that you can call or message throughout the entirety of your treatment. Please do not hesitate to get in contact with the breast care nurses if you have any questions.
Breast cancer management usually involves a combination of different treatments, which are explained in further detail on this page.
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Surgery
The aim of surgery is to remove breast cancer and may involve:
Breast conserving surgery (also known as Wide Local Excision or Lumpectomy)
The breast cancer is removed with a margin of normal breast tissue around it. Radiotherapy is usually given to the rest of the breast to reduce the risk of the breast cancer recurrence.
Oncoplastic breast conserving surgery
The breast cancer is removed with a margin of normal breast tissue around it, with immediate reshaping and/or remodelling of the defect to improve the cosmetic appearance of the breast. In some people this can enable better targeting for radiotherapy, which is normally given to the rest of the breast.
Mastectomy
This is the removal of the entire breast, the skin and the nipple. If you have a mastectomy you will be fitted with a temporary, soft prosthesis (a comfie) by the breast care nurse prior to discharge. Once the scar is healed (a minimum of six weeks) you will be provided with information for the next steps for fitting a semi-permanent, silicone breast prosthesis (breast form). A mastectomy may be performed in conjunction with breast reconstruction where appropriate.
Breast Surgery Information
Axillary (or underarm) surgery in breast cancer
Lymph glands or lymph nodes in your armpit may need to be removed, to find out if the cancer has spread, and to help decide if further treatment after surgery may be beneficial.
Sentinal Lymph Node Biopsy
Some patients have a sentinel lymph node biopsy, where a small number of lymph nodes (usually between one and four) are removed. The number of nodes removed varies in everyone.
Before your axillary surgery you will need a pre-operative injection into the breast to identify the drainage through the lymph channels to the first lymph nodes. This procedure will be undertaken in the Nuclear Medicine Department at University Hospital Southampton. You may also have an injection of blue dye during the operation to help locate the lymph nodes.
The removed lymph nodes are analysed with the breast tissue. If they contain cancer cells additional nodes may need to be removed. This is called an axillary clearance.
Axillary clearance:
If the initial investigations show cancer cells in the lymph nodes prior to surgery you may be recommended to have an axillary clearance. If there are cancer cells detected in the sentinel lymph node(s), depending on individual circumstances, you may be advised to have an axillary clearance or radiotherapy to the armpit as part of your treatment.
Breast Reconstruction
Breast reconstruction is surgery to create a new breast shape after an operation to remove the breast (mastectomy) or part of the breast. Breast reconstruction can be done using your own tissue (autologous reconstruction), a prosthetic implant or a combination of both with the aim of reconstructing a natural looking breast. Breast reconstruction may involve keeping the majority of the breast skin (skin sparing mastectomy), or even the nipple (nipple sparing mastectomy), if it is safe to do so.
If your nipple is removed a new nipple can be reconstructed at a later date. Using advanced techniques, a 3D illusion tattoo can restore the look of a natural nipple-even if one is no longer physically present. An areola can also be tattooed alongside a surgical nipple reconstruction.
Read more about nipple tattooing here.
Further information about breast reconstruction can be found here:
What to expect when you have breast surgery
Breast surgery is usually the first treatment recommended for most people who are diagnosed with a breast cancer. Most patients are discharged home on the same day (Day case procedure) or the day after their operation once they have recovered from the anaesthetic. Some patients may stay in hospital longer if they have other medical conditions that require close monitoring or if breast reconstruction has been undertaken. You will be provided with a 24-hour contact number to the ward in addition to your breast care nurse’s contact number.
Most patients experience some degree of mild to moderate pain and tingling/numbness at the site of surgery (breast/armpit/both). Over-the-counter pain relief like paracetamol or Ibuprofen are usually sufficient, but Dihydrocodeine can be used in case of severe pain, all of which will be provided to you on discharge.
Mild swelling and bruising are common and expected after surgery, however, contact the specialist Breast Care Nurses or the ward if this is rapidly increasing, or feels tense, warm or red.
Before you leave the hospital, your nurse will give you information about dissolvable sutures, the use of showerproof dressings or special medical glue to help manage the wound. A surgical drain/tube may have been inserted into the wound to help drain the fluid that might gather under the wound.
If you have any concerns with how your wound is healing, you can contact us to organise a review.
Additional Breast Surgery Information
Further information about breast surgery can be found here:
Chemical Treatment
It may be necessary for some treatment pathways to use chemical medicine, in conjunction with surgery. Read more about chemical medicine treatment below.
Chemical Treatment Information
Chemotherapy
Chemotherapy is the use of anti-cancer (cytotoxic) drugs to destroy cancer cells. There are many different chemotherapy drugs used alone or in combination to treat different types of cancer. These drugs stop cancer cells from dividing and reproducing and, as the drugs are carried in the blood, they can reach cancer cells almost anywhere in the body. They affect rapidly dividing cells and so can also affect rapidly dividing healthy cells, healthy cells unlike cancer cells can repair themselves and recover. Chemotherapy treatment is tailored to each patient and is given as a series of cycles. Each cycle is followed by a rest period.
Chemotherapy is an important treatment for breast cancer; it can be given before surgery (called neo-adjuvant chemotherapy) to shrink (and sometimes completely destroy) high risk cancer before surgery. Chemotherapy given after surgery (called adjuvant chemotherapy) is given to kill residual microscopic disease to prevent the risk of cancer recurrence.
Chemotherapy is also used for people with secondary breast cancer (breast cancer elsewhere in the body) to control the disease. If this is your diagnosis, there is a team to help support you. The risks and benefits will be discussed with you so you can make an informed decision about your treatment.
Your individual case will be discussed in the UHS MDT Meeting to decide the best treatment approach (including chemotherapy) and these treatments will be discussed by our Medical Oncologists including all the risks and benefits for each individual. In selected patients, we use genomic assay tests such as Oncotype DX to help us predict how likely breast cancer is to spread to somewhere else in the body. This information is used to guide decisions about the benefit of chemotherapy and again we discuss this in detail with you if it is applicable.
Information about breast cancer genomic tests we use can be found here:
Oncotype DX Breast Recurrence Score® Test – About the Test
Prosigna Patient Information
Haircare
We recognise that potential hair loss can be a common worry as a side effect of chemotherapy. Our team is dedicated to supporting patients both physically and emotionally, helping to maintain confidence and wellbeing throughout treatment. We are proud to offer personalised hair care advice with Layla Vaughan, an Enhanced Oncology Support Worker and qualified hairdresser. Layla offers compassionate, practical hair care advice in addition to the option of scalp cooling which can minimise hair loss during chemotherapy, all of the nurses within the chemotherapy unit are trained to use scalp cooling techniques alongside chemotherapy. Haircare support with Layla includes:
• Advice on hair care before, during and after chemotherapy
• Guidance on scalp cooling to reduce hair loss
• Support with wigs, where to purchase wigs, hairpieces and headwear.
• Emotional reassurance in a private, supportive environment
• Haircuts during chemotherapy.
Prior to your treatment you will be invited for a pre-chemotherapy discussion with an oncology nurse as another opportunity to ask any questions. At this point you will be given a 24-hour contact number.
At the Spire Southampton there is a unit which houses 6 individual rooms to maintain privacy, all of which are fitted with a television. You will be provided with meals and refreshments throughout your treatment and you may bring a family member or friend with you also
Precision Medicine: Targeted therapies
Invasive breast cancer is divided in 3 main groups according to 3 main receptors on the surface of the cancer cells: ER+ (oestrogen receptor positive), Her2+ and Triple Negative Breast Cancer (TNBC). There are groups of treatment that target these receptors making treatment precise, targeted, less toxic and more efficient.
For example, Immunotherapy allows the individual’s immune systems to fight cancer. It works by harnessing/empowering the immune system to recognise and kill cancer cells. We also have oestrogen blockers and anti Her2 inhibitors, which are very effective. These drugs can be used to treat specific subgroups of breast cancer before or after surgery and in people with secondary breast cancer (breast cancer elsewhere in the body).
Additional information about targeted therapies can be found here:
Endocrine (hormone) therapy
Endocrine therapy or hormone therapy is a treatment offered to people with hormone (oestrogen) dependant breast cancers (known as ER positive breast cancer). These tablets work by either blocking oestrogen receptors or preventing the production of oestrogen in the first place. This type of therapy may be suitable for up to 75% of patients. This will depend exactly on the type of cancer and whether it is sensitive to this type of treatment.
Endocrine therapy involves taking a tablet sometimes before surgery, but more often for five to ten years after your operation to reduce the chances of the cancer returning. For some women who cannot have surgery due to the severity of other underlying medical conditions, endocrine treatment may be the recommended treatment to help control the cancer.
Additional information about endocrine therapy can be found here:
Bisphosphonates
Bisphosphonates are traditionally a group of drugs used to treat or prevent osteoporosis (bone thinning). However, bisphosphonates have been shown to reduce the risk of cancer returning in the bone in postmenopausal women with high risk (large, Grade 3, or lymph node positive) cancers. A medical oncologist will discuss this treatment with you if you will benefit from it.
They are also sometimes used in the treatment of secondary breast cancer that has spread to the bones.
Additional information about bisphosphonates can be found here:
Radiotherapy
Radiotherapy is the use of high energy x-rays to destroy cancer cells. Rapidly growing cells such as cancer cells are more susceptible to the effects of radiation therapy than normal cells. The X-rays are painless and invisible. The treatment does not make you radioactive and it safe to be around other people, including children after treatment.
Radiotherapy Information
What is radiotherapy?
Radiation is an effective way to reduce your risk of breast cancer recurring after surgery. It may be given to the remaining breast tissue in the case of breast conservation, or to the chest wall (after mastectomy) and in some cases to the regional lymph nodes.
In secondary breast cancer radiotherapy is commonly used to ease the symptoms caused by cancer that has spread to other parts of the body.
Radiation therapy may be delivered externally or internally. For breast cancer this is normally external beam radiotherapy i.e. radiation from a machine outside your body (linear accelerator) that delivers the treatment.
Treatment & recovery
You will need to see the team first to plan the radiotherapy treatment. A CT scan will then be done within the radiotherapy department to plan the treatment.
Treatment is normally 5 – 15 daily sessions dependent upon individual results. It will normally be given within 6 -12 weeks of surgery depending on wound healing. If you are recommended chemotherapy treatment radiotherapy normally starts a month after the final chemotherapy date.
Side Effects
In the short-term patients may experience fatigue and a localised skin reaction in the treated area. In the longer term it may cause some altered texture of the skin.
Radiotherapy may not be recommended for some people. For example, those who have had previous radiotherapy for other disease in the upper part of the body or people with certain medical conditions, or movement disorders radiotherapy may not be suitable.
Additional information about radiotherapy can be found here:
Follow up after Breast Cancer Treatment
After you have completed your breast cancer treatment, or a combination of treatments, we will discuss your tailor-made follow-up schedule with you.
Follow up Information
Mammograms
You will have regular mammograms as part of your prescribed imaging follow up. You can also have mammograms as part of the NHS Breast Screening Programme as long as there is a year between mammograms.
Lymphoedema after breast cancer treatment
Lymphoedema is swelling caused by a build up of fluid in the body’s tissues. This can happen after breast cancer treatment when lymph nodes are removed, or lymph vessels may be damaged by surgery or radiotherapy. It can occur during or immediately after treatment or sometimes many years later.
Lymphoedema may affect the arm or hand on the affected side, or the breast or chest area. It is thought to affect about 20% of people who have breast cancer treatment. It can be successfully managed with various techniques.
If you are at risk of developing lymphoedema it is important to protect your affected side from damage. It is usually recommended to avoid injections, blood samples and taking blood pressure from the at risk side, and to keep the skin in good condition.
It is also recommended that you keep as active as possible, exercise regularly and maintain a healthy weight.
Early signs of lymphoedema can include stiffness in the joints, dry skin, heaviness or aching in the affected area, and tightness of clothing or jewellery. Swelling may come and go in the early stages, and it is important to discuss any changes you notice with your GP or consultant.
You may be referred to a lymphedema specialist for assessment and advice. Most people find that their swelling improves with a combination of skin care, specific exercises which improve the lymphatic drainage, and a special type of self-massage which helps to redirect the excess fluid. Some people also use compression garments (sleeves, gloves or bras) to control the swelling.
Although lymphoedema is not dangerous it can increase the risk of developing a skin infection, or cellulitis and it is very important that you seek medical advice if you show any sign of infection such as increased swelling, pain and redness in the affected area.
Additional information can be found on the Lymphoedema Support Network website
Underwear, Breast Forms and Swimwear
Nicola Jane are award winning experts in post-surgery products after breast cancer for over 40 years. The breast care specialists who work at Nicola Jane offer free support, breast care advice and bra fitting services for all women to help women feel confident post breast surgery. Whether you have undergone a full mastectomy, lumpectomy or need a breast form to help provide an even shape, the breast care specialists provide fittings in post-surgery bras, breast forms and swimwear. Nicola Jane offers a wide range of breast forms in different shapes, sizes and weights to suit all your needs, with stores located throughout the UK, and the nearest store in Chichester.
Breast care specialists from Nicola Jane visit the The Hampshire Breast Clinic at the Spire Southampton to meet patients and offer breast care advice and bra fitting services throughout the year. Please speak to one of our Breast Care Nurses for these dates.
There are also regular Free Nicola Jane Bra fitting services monthly at Maggie’s.
For Further information please visit the link below:
Mastectomy Bra and Post Surgery Bra Specialists – Nicola Jane
Further information about breast reconstruction can be found here:
Breast Reconstruction – Breast Cancer Now
Breast Reconstruction – Macmillan Cancer Support
Breast Reconstruction – Cancer Research UK
Breast Reconstruction – BAPRAS
Reducing risk of breast cancer
- Keep to a healthy weight
- Healthy diet
- No or low alcohol intake
- Exercise regularly
- Breast feeding
- Medicines such as aspirin or anti-inflammatory drugs
- Surgery or hormone treatment if you at high risk of developing breast cancer
- Be breast aware
More information can be found on the following websites:
