'Save a breast, or a woman's life It's a simple choice,' says breast cancer surgeon Lester Barr
Over the course of my career, I’ve had to diagnose thousands of women with breast cancer. There is no easy way to break such devastating news.
Even when the prognosis is good – and in many cases it is, thanks to early diagnosis – patients are understandably gripped by an overriding fear. Will they have to lose their breasts
It is a horrifying prospect for any woman, and the assumption still prevails that the disease can be treated only with a mastectomy. In other words, if the surgeon is to save a patient’s life, then he or she has no choice but to remove all the breast tissue.
Encouraging statistics: Many women retain their figure after surgery
Certainly the ongoing investigation at Solihull Hospital in the West Midlands, where risky, so-called ‘cleavage-sparing’ mastectomies have led to at least one patient contracting breast cancer again, would point to this. It has been said that one of the hospital’s experienced surgeons, Ian Paterson, was leaving small amounts of breast tissue around the cleavage in some women with the intention of giving them a better cosmetic result.
There has been one confirmed repeat cancer diagnosis and 12 women have been recalled to have any remaining tissue removed. Many hundreds more are being reviewed.
The case is being investigated by the General Medical Council.
Despite this, it is vital to reassure the 50,000 women diagnosed with the disease each year that a full mastectomy is not the only way. It is critical that any woman facing a breast cancer diagnosis understands all the options available to her.
It is a horrifying prospect for any
woman, and the assumption still prevails that the disease can be treated
only with a mastectomy. In other words, if the surgeon is to save a
patient’s life, then he or she has no choice but to remove all the
The picture is by no means unremittingly bleak. It is down to a specialist to guide his patient, but by arming yourself with the facts, you can make an informed decision about which kind of treatment options best suit you.
If a malignant lump is small (less than 4cm), then a lumpectomy – removal of the lump – can be carried out: early breast cancer survival rates are similar for both a mastectomy and a lumpectomy.
A lumpectomy is usually accompanied by radiotherapy to ensure that no surrounding tissues are harbouring cancer cells.
There have been concerns that radiotherapy itself can trigger the disease, but this is very rare – one in 2,000 cases – and it reduces the risk of relapse by a further 50 per cent.
Surgery doesn't have to mean woman has to have both of her breasts removed if one is perfectly healthy
If there is more than one lump in the breast, meaning that the cancer has spread, then a lumpectomy is too risky, as cancerous cells could remain. Likewise, if the cancer is right behind the nipple or if a woman has a family history of the disease, a lumpectomy will not be enough, and in these cases we would advise a mastectomy.
The aim of the operation is to surgically remove as much breast tissue as possible – a surgeon should be able to take away about 99 per cent. It’s simply not possible to get every last bit because a breast is not like a kidney, which has well-defined edges.
Can there ever be a trade off Saving a breast or a life
But surgery doesn’t mean a woman has to have both of her breasts removed if one is perfectly healthy. Some patients may choose this option to remove the risk, albeit small, of developing breast cancer again.
Of those who have only a single mastectomy, about five per cent will develop cancer in the remaining breast after ten years.
Even with such a raft of encouraging statistics and the development of medical techniques, the prospect of a mastectomy remains horrifying. Unfortunately, cutting away or radiating the cancer is the only way to treat a localised area of the disease.
The good news is that thanks to advances in reconstructive surgery, it is possible for women to retain their figure.
Furthermore, this can be done during a mastectomy – a move that provides a huge psychological advantage for the patient. It softens the blow of waking from the operation and dealing with the loss of the breasts.
Sometimes it may be possible for a surgeon to preserve the outer skin or even the nipple when they are removing breast tissue. Unfortunately, the more you leave behind, the greater the risk of the disease recurring.
This begs the question: Can there ever be a trade-off between saving a breast and saving a life I think the women treated at Solihull Hospital may, unfortunately, already know the answer to that one.
lThe writer is a consultant surgeon specialising in treatment of breast cancer and breast reconstruction at the Genesis Breast Cancer Prevention Centre, Wythenshawe Hospital, Manchester.