Breast Surgery

The information below on breast disease and surgery is general in nature and should be read as a guide only. It is not definitive medical advice. Dr. Anderson will discuss patient specific requirements based on their medical history and diagnosis during a consultation.

​

Dr. Will Anderson is an expert in benign and malignant breast disease with extensive experience in the work up and management of common presentations such as a new breast lump, nipple retraction and nipple discharge. 

Breast Disease  

Benign ​

It is important that men and women are ‘breast aware’ and any new changes are checked by their GP or surgical specialist.  Changes may include new lumps, a thickening of tissue or changes to the skin or nipple.  The Breast Cancer Foundation has great resources on their website about how to check for changes. 

​

If you do notice changes, it may not be anything troublesome.  The breast is an ever-changing gland that evolves over a women’s lifetime. During the different phases of life, different changes can produce a palpable lump. In younger women in their 20s, the breast is in its proliferative phase and the commonest lumps are benign overgrowths of connective tissue called fibroadenomas. As you progress into the 30s and 40s, you enter the mature and then involutionary phase of the breast, where glandular tissue is replaced by fat. Here the commonest lump is a cyst that generally forms from the glandular tissue which becomes disorganised as it degenerates. 

Changes can also occur in the central milk ducts which drain to the nipple. There are around 15 to 20 of these large central ducts and they can become blocked causing them to distend and produce thickened secretions. This is a process called duct ectasia and is a very common cause of nipple discharge. More rarely, nipple discharge, particularly if clear or blood stained, can be caused by growths or even cancers involving the ducts, so nipple discharge should always be assessed by a professional. 

Malignant  

Breast cancer is a common problem in New Zealand, affecting around 1 in 10 women in their lifetime and 1 in 1000 men. It typically presents as a new breast lump, but may present as a lump in the axilla (armpit), new nipple retraction or bloody nipple discharge. Urgent assessment of these symptoms with clinical examination, imaging and a biopsy where required, helps identify cancer quickly and get patients to the treatment they need as soon as possible. 

​

Thankfully, most breast cancers are caught early, when they are still in the breast and nowhere else. These cancers are considered curable and require surgery to the breast, which can either be a mastectomy where the whole breast is removed or a lumpectomy where just the cancer is removed. If just the cancer is removed, then radiation is required to the remaining breast tissue around 6-8 weeks after the operation. These two options of mastectomy or lumpectomy & radiotherapy are equivalent when it comes to long term cancer control. Patient outcome questionnaires show that patients are happier on average, when they have surgery that keeps the breast. However, it is a very personal choice and a decision we will support you through if you are faced with it.  

​

More advanced cancer that has spread to the axilla (armpit) often requires more aggressive surgery to remove the lymph nodes under the arm. These are the small glands that process tissue fluid from the breast and are the first place that cancers of the breast spread to. These more advanced cancers also normally require systemic therapies that treat the whole body and help reduce the chance of cancer coming back in the future. These treatments depend on the cancer type, but can take the form of chemotherapy or hormone therapy.  

Breast Surgery  

Breast surgery is a complex area with many different options depending on the specifics of your cancer.  The options for you will be discussed during a consultation.

​

Mastectomy 

Mastectomy is removal of the whole breast. It can be performed in various ways but most commonly the nipple is taken with the breast, and a sideways scar is fashioned across the chest wall. Once healed, a prosthesis can be worn in the bra so that there is good symmetry under clothing. 

​

Lumpectomy  

Lumpectomy is removal of the breast cancer with a margin of surrounding normal breast tissue. The remaining breast is then closed back together to re-create the breast mound. This is a good option for smaller cancers and will often leave a slightly smaller breast but preserve the natural contour. For benign disease, this procedure is sometimes done to remove a symptomatic lump. When done for breast cancer, this procedure is always done in partnership with radiotherapy which happens 6-8 weeks after surgery. 

​

Oncoplastic Breast Surgery  

For larger breast cancers, the size or shape of the breast has to be modified to allow the cancer to be removed whilst achieving a good cosmetic outcome. This is called oncoplastic breast surgery. Careful dissection of the breast gland is performed, as well as modification of the skin envelope that covers the breast. This can take many forms but allows us to use the breast conserving approach for far more cancers. For patients with a degree of droop or ptosis in the breast, a breast reduction or breast lift is often employed to lift the whole breast whilst removing the cancer. This can be a good choice to give a better cosmetic outcome but does usually require surgery on the non-cancer side to make sure both sides are similar 

​

Axillary Surgery

Even when the lymph nodes in the armpit (axilla) feel and appear normal, surgery is usually recommended to check whether breast cancer has spread. In around 15–20% of cases, small amounts of cancer may be present in the lymph nodes but are not detectable on initial examination or imaging. Identifying this is important, as it helps determine the most appropriate treatment plan.

​

A sentinel lymph node biopsy is the procedure most commonly used. This involves injecting a small amount of tracer near the nipple, which travels to the first lymph node(s) that drain the breast (the “sentinel” nodes). During surgery, this tracer helps the surgeon locate and remove these nodes. They are then sent to the laboratory for detailed analysis alongside the breast tissue.

In cases where the cancer is more advanced or has clearly spread to multiple lymph nodes, a more extensive procedure called an axillary clearance may be required. This involves removing more lymph nodes from the lower part of the armpit.

While effective, axillary clearance can carry a higher risk of side effects, including:

• Swelling of the arm (lymphoedema)

• Altered sensation in the inner upper arm

• Shoulder stiffness

Your surgical team will discuss the most appropriate approach for you, balancing accurate staging of the cancer with minimising potential side effects.

​

Duct Excision 

For nipple discharge, an incision is usually made at the edge of the areolar and the central ducts removed from the behind the nipple. This is very successful at stopping nipple discharge and also allows the pathologist to check that there are no concerning changes in the ducts themselves.  

​

If only one duct is involved, a more conservative approach can be employed that makes a small incision on the nipple itself and removes just the particular duct causing the problem. Preserving the rest of the nipple and central milk ducts. This is called a microdochectomy. 

​

Breast Reconstruction 

When a mastectomy is required, a breast can be reconstructed. This requires a longer operating time and more complex surgery but can provide a good cosmetic outcome with volume replacement that looks like a breast in swim wear or underwear.  A reconstructed breast will never look or feel entirely like a native breast.  

​

Reconstruction can be done immediately at the time of the initial cancer surgery or in a delayed fashion, if other cancer treatments are required. The volume lost when we remove the breast can be replaced with silicone (implant-based reconstruction) or with tissue taken from elsewhere in the body (tissue based reconstruction).  

Dr. Anderson provides immediate and delayed implant-based reconstruction in Whangarei. Tissue based reconstruction can be arranged with plastic surgical specialists in Auckland and is not performed in Whangarei.