Breast wide local excisions, also known as lumpectomy or wide local excision with cavity shaving, are surgical procedures performed to remove breast tumors while preserving as much of the healthy breast tissue as possible. During the procedure, the surgeon removes the tumor along with a surrounding margin of healthy tissue. The goal is to achieve clear surgical margins and ensure the complete removal of cancerous cells. Breast wide local excisions are commonly used for early-stage breast cancer or for the removal of benign breast tumors. This technique allows for breast conservation while maintaining oncological principles.
Segmental mastectomy, also known as partial mastectomy or quadrantectomy, is a surgical procedure performed to remove a larger portion of the breast tissue while preserving the breast's overall shape. It involves removing the tumor along with a segment or quadrant of the breast tissue surrounding it. This procedure is often performed for larger tumors or when breast-conserving surgery is not feasible. Segmental mastectomy is typically followed by radiation therapy to target any remaining cancer cells and reduce the risk of recurrence. It aims to achieve oncological clearance while maintaining a satisfactory cosmetic outcome and preserving a significant portion of the breast.
Total mastectomy, also known as simple mastectomy, is a surgical procedure performed to remove the entire breast tissue. During the surgery, the breast tissue, including the nipple and areola, is removed. Total mastectomy is often recommended for larger tumors, cases of extensive ductal carcinoma in situ (DCIS), or when the patient chooses to undergo a mastectomy instead of breast-conserving surgery. The procedure may also involve the removal of axillary lymph nodes for further evaluation. Total mastectomy is an effective treatment option for breast cancer and may be followed by breast reconstruction to restore the breast's appearance.
Skin and nipple-sparing mastectomy is an advanced surgical technique that should only be performed by experienced breast surgeons like Dr. Malherbe. This procedure aims to remove breast tissue while preserving the natural skin envelope and nipple-areola complex. By carefully accessing the breast tissue through discreet incisions, the surgeon can achieve a more aesthetically pleasing outcome for patients undergoing mastectomy. Skin and nipple-sparing mastectomy not only helps in maintaining the natural appearance of the breast but also offers psychological and emotional benefits to patients. This innovative approach underscores Dr. Malherbe's commitment to providing comprehensive and patient-centered breast surgical care, empowering individuals to regain their confidence and quality of life.
This is carried out to restore the shape of the breast following mastectomy. There are a number of different techniques used to achieve the reconstruction. These will be explained and discussed with the patient as part of the treatment process by both the Breast Surgeon and also the Plastic Surgeon. It may be undertaken immediately after the mastectomy by the surgeon who carried out the procedure (a oncoplastic surgeon), or by a plastic surgeon working with the breast surgeon. Alternatively it may be carried out at a later date. If this is planned provision will be made for the subsequent procedure at the time of the mastectomy. Patients, who choose not to have reconstructive surgery, will be advised about prostheses (false breasts).
At operation a very small vacuum tube drain, 3mm in diameter, is usually inserted in order to prevent undue bruising. In order to obtain the best possible cosmetic result the skin wound is closed in three layers. The deep breast tissue is closed with soluble stitches, which are gradually absorbed by the body. Some thickening may occur under the scar for a few months, while this process occurs and the wound settles. The closure is completed by a single subcuticular suture with steristrips holding the skin edges together.
Breast excision biopsy performed in a theatre under general anesthesia is a surgical procedure used to obtain a tissue sample from a breast abnormality for further evaluation. The patient is given general anesthesia, ensuring they are unconscious and pain-free throughout the procedure. In the operating theatre, the surgeon makes an incision over the suspicious area and removes a portion of the breast tissue containing the abnormality. The tissue sample is sent to the pathology laboratory for analysis. Performing the excision biopsy in a theatre allows for precise control and optimal conditions for the surgeon, facilitating accurate and thorough sampling.
Magseed-guided excisional breast biopsy is a procedure used to remove impalpable breast tumors or suspicious areas identified through imaging, such as mammography or ultrasound. The procedure involves the placement of a small stainless steel seed, guided by imaging technology, into the precise location of the abnormality. The seed serves as a guide for the surgeon during the biopsy and can be found, ensuring accurate removal of the targeted tissue. Once the seed is in place, the surgeon makes an incision and detect the seed using a metal detector to remove the abnormal tissue. Magseed-guided excisional breast biopsy is an effective method for obtaining tissue samples from impalpable tumors, aiding in accurate diagnosis and appropriate treatment planning.
The tissue excised undergoes instant preliminary analysis in the operating theatre by a Histopathologist. The tissue examined can include the section which appeared abnormal and the margins or surrounding area. The specimen will subsequently receive more detailed analysis in a laboratory.
Lymph nodes or glands are removed through the axilla or armpit, to ascertain whether the cancer has spread to the lymph glands. This is usually undertaken at the same time as surgery to remove a tumour. If the cancer is near the axilla a single incision can be used. During a mastectomy, the gland will be removed through the mastectomy incision. The lymph nodes removed will be analysed by a Histopathologist.
This technique has been the subject of a number of clinical trials around the world. It is used to identify whether cancer has spread to the lymph nodes. Dr Malherbe uses a technique called Sentimag and has been the first surgeon in Africa to use this technique. It involves injecting a small amount of iron oxide, which identifies the sentinel node, this is the first node to receive lymph fluid from a tumour. If the sentinel node is clear, it usually means that the other nodes are clear and removal of further lymph nodes under the arm may not be necessary.