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Surgery for breast lumps SURGERY FOR BREAST LUMPS
Many of the operations for diseases of the breast are relatively simple, causing little trauma. Although almost all breast surgery is done with a general anesthetic, the surgical approach varies from surgeon to surgeon.
The minor breast operations leave little cosmetic defect, and the incisions used should produce acceptable scars. However, removal of a breast to treat cancer is a mutilating procedure, and the decision to go ahead with this type of surgery is one that is not taken lightly. If you are to have an operation to remove a breast, time should be allowed for you to receive counseling beforehand, and you should be absolutely certain that you understand what is involved. Apart from the mutilation - both physical and psychological - which may be extensive, there may be plans for you to undergo post-operative chemotherapy and radiotherapy. All aspects of these treatments should be explained clearly to you by medical staff, and you should understand them sufficiently to be able to give your fully informed consent. It is a good idea to talk to your breast care nurse about the treatment that is proposed for you at this stage.
Surgery for benign diseases
Incisions
Most incisions on the breast can be cosmetically made, particularly if the operation is simply to remove a breast lump. The incision follows the natural crease lines of the skin, known as Langer's lines. If a truly cosmetic crease line cannot be used, the incision can be hidden within the 'bikini bra' line. Incisions can be circumferential or radial on the breast.
Peri-areolar incisions
Incisions made around the pigmented part of the breast allow access to the ducts behind the nipple and to any centrally located breast lumps. Most of these incisions are closed with a subcuticular skin suture which is placed from side to side at the skin edges, leaving a fine white line once healing is completed -after about 6 months. The risk of infection or cosmetically unacceptable scars following incisions of this type is low.
Sub-mammary incisions
A sub-mammary incision can be made in the crease underneath the breast to remove the breast completely. The skin and nipple are left intact, together with their blood and nerve supplies. Sensation is therefore retained in the breast area. An implant can then be placed under the skin, or the breast can be reconstructed in some way. Complete removal of the breast by this route is not now commonly performed, and it is certainly not used for operations to treat cancer. It has, however, been used to remove the breast in extreme cases of breast pain.
The sub-mammary incision can also be used to remove a large breast in a male, again with a good cosmetic result.
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