Insight from a surgical breast cancer specialist

While there are numerous risk factors associated with the increased incidence, most women who develop cancer of the breast may not have done so due to any risk increase, except for the fact that they are female, and growing older.

How can one improve early detection?
Screening for breast cancer tries to identify the lesion before it is clinically detected, which has great benefits for those unfortunate enough to develop cancer.  The earlier caner is detected and diagnosed, the better the outcomes of treatment, and increases in survival of the disease. For this reason doctor advise that breast cancer screening including radiological screening such as mammography, ultrasound tests and in some cases a MRI of the breasts be done regularly.

Between the age of 40 to 50 years, depending on the results of monthly self-inspection and regular checks by your doctor as well as your family history of cancer incidence, it is recommended that mammograms and in some cases also ultrasounds, when the breast tissue is very dense, be done every couple of years.

I found a lump! What do I do?
Your breast clinician who may also be your gynaecologist or GP, will perform the initial clinical assessment should an abnormality arise.  They are able to interpret the information regarding the imaging and can assist with deciding on the most appropriate diagnostic technique. A biopsy is most often done and will assist in confirming whether the abnormality is malignant or benign.  Dr Pramod Reddy, a full-time specialist breast and general surgeon based at the Busamed Gateway Private Hospital advises that the biopsy to assist in confirming the pathological nature of the abnormality may be done by a radiologist or your breast clinician.

“If cancer is confirmed, then one should schedule an appointment with their surgeon. The surgeon must clinically assess the patient, stage the disease, and plan the appropriate management, which may include systemic therapy first. The surgeon should normally involve the oncologist at this stage,” he explained.

Breast conservation therapy?
Reddy said that patients in whom early breast cancer of the first two stages has already been detected might be candidates for breast conservation therapy (BCT) which has similar survival outcomes to mastectomies but is carried out through various means including a wide local excision, quandrantectomy of the breast, or even a skin sparing mastectomy. He said that some studies of those patients with early breast cancer have actually demonstrated added survival benefits in the BCT group and it has become internationally recognised as the treatment of choice for early stage breast cancer as long as there are no contraindications to the patient having radiation therapy following surgery.
“Sometimes BCT cannot be offered in patients with early breast cancer (due to multiple lesions (multicentric disease) or inadequate breast:tumour-size ratio) and therefore they would require a Mastectomy. All these patients should be offered the option of reconstruction, either immediate or in the delayed setting,” explains Reddy.

Psychological impacts of breast loss
Reddy said that although there has been great inroads in the early detection of breast cancers, the incidence of full mastectomies in which the entire breast is removed, is till very high. “It is still being done far too often,” he said explaining that women who have had mastectomies are at an increased risk of developing a negative impact on their psycho-social behaviour which can lead to depression, social anxiety and becoming withdrawn in company compared to those who have had breast conservation therapy.

What about reconstruction?
Reconstruction is the creation of a “new breast” following surgery for removal of cancer of the breast. The decision to reconstruct and which method to use must always be performed as part of a Multi-Disciplinary Team (MDT) review, which involves communication between the Surgeon, the Reconstructive Surgeon, the Radiologist, and the Oncologist, and of course, the patient.

Reconstructions are usually done either immediately at the same time as the mastectomy or delayed from six months after the mastectomy. Different methods of reconstructing the breast include the use of the patient’s own body tissue, know as an autologous tissue transfer, or the use of a prosthetic implant.  Oncoplastic techniques for reconstruction include glandular mobilization techniques, local flaps for volume replacement following large defects treated with BCT, to whole breast reconstruction.  It is important to realise that not all patients are ideal candidates for a reconstructive procedure. “Your breast surgeon will be key in making the decision together with the reconstructive surgeon,” said Reddy. “Reconstructions done by an oncoplastic team have the best outcomes. These procedures are safe with complications being minimized in the experienced hands. All treatment plans are individualised, with patient selection and appropriate reconstructive choice being confirmed and agreed upon by the surgical oncology team.”

Will Medical Aids cover these procedures?
While it will depend on what plan you are on, most Medical Aid schemes, do cover at the very least, part of the reconstructive procedure making this treatment choice possible. “All females with early breast cancer, should be afforded the opportunity to consider reconstruction,” said Reddy. “With the recent advances in the surgical management of breast cancer, we are able to provide women affected by breast cancer some light, by minimizing the personal impact, the psychological challenges and the physical deformity associated with the surgical management of this devastating disease.”

Dr Pramod Reddy can be found at Suite 504 at Busamed Gateway Private Hospital. Phone for an appointment on 0314921278 or email durbansurgeon@gmail.com.

Dr Reddy is a full-time specialist breast and general surgeon based at the Busamed Gateway Private Hospital. He is the Director of the Durban Breast Clinic and The Surgical Screening Clinic. He is a Fellow of the College of Medicine of South Africa (CMSA) and is currently completing his PhD in the field of Breast Cancer. He was the consultant in charge of the Addington Breast Clinic and was part of the Combined Breast Oncology Clinic at Inkosi Albert Luthuli Hospital from 2008-2016. He is a founding member of the Breast Interest Group of Southern Africa (BIGOSA) and is a member of the South African Research Society. His special interests include malignant and benign breast conditions and reconstructive breast surgery. He also obtained a diploma in Laparoscopic Surgery at the University of Strasbourg in France. The Durban Breast Clinic is a diagnostic breast centre based in Durban North and is currently relocating to Busamed Gateway Private Hospital.