Therapeutic mammoplasty
Therapeutic mammoplasty (TM) is an operation to remove a breast lesion and reduce or lift the breast at the same time. It combines a wide local excision with a tailored breast reduction or lift.
The scars will depend on your breasts and your cancer but may be all around the areola, around the areola and down or an "inverted T" or anchor shape.
Sometimes a localisation wire is needed to help the surgeon remove the right part of the breast
Key points
  • Operation to remove breast cancer and reduce or lift the breast
  • Usually have surgery to both breasts
  • Usually an overnight stay
  • May need localisation
  • Likely to need radiotherapy
  • Post surgery bra for 6 weeks

Alternatives

Anyone with breast cancer can choose to have a mastectomy (removal of all the breast tissue). Women can choose to “go flat” and most women are suitable for some type of breast reconstruction. 
Depending on the size of your breast cancer relative to your breast, you may be able to have a simple Wide Local Excision and avoid a breast reduction.

If you are suitable for neoadjuvant therapy (chemo- or endocrine therapy before surgery) your tumour may shrink enough to avoid the need for a breast reduction

Potential problems
  • Bleeding, including a pocket of blood under the skin (haematoma) (5%)
  • Wound infection (<5%)
  • Wound breakdown
  • Altered nipple sensation
  • Asymmetry
  • Skin necrosis (<1%)
  • Nipple necrosis (rare)
  • Fat necrosis
  • Breast cancer recurrence (1% per year)
  • Blood clots (DVT/PE)
  • Risk of anaesthesia (low)
Associated treatment
Most women having TM will also need surgery to check the lymph glands in the armpit. Nearly all will be advised to have radiotherapy. Choosing a mastectomy can avoid the need for radiotherapy.
You will probably also want to have the other breast reduced to match the affected breast. You are advised to wear a post-surgery bra night and day for 6 weeks.

Many women with breast cancer are recommended to take hormonal therapy for several years. This depends on the biology of your cancer and will be discussed with you in detail if needed.

Some women are recommended to have chemotherapy or targeted therapy for several months. Again this depends on the biology of your tumour and you will discuss this in detail with your medical oncologist if needed.
On the day of surgery
You will need to fast for 6 hours before surgery. You can take any medications as normal and continue to drink water until 2 hours before surgery.
You should shower and wash well in the morning. Bring something to do as there will be a lot of waiting.
When you arrive you will be checked in by the nurses and change into a gown and stockings ready for the operation.
In the holding bay
You will see your surgeon and anaesthetist, have a drip put in and have the operative site marked. You might also be given premedication.
In recovery
After surgery you will go to recovery. You will be watched closely until you are alert and well enough to return to the ward. You might be given medication for any sickness or pain.
After surgery
Swelling or bruising is common and usually settles on its own. You may have a drain to prevent fluid building up under the skin. This is usually removed after a few days.

Your dressings will be splash resistant but try not to soak them. Pat them dry after a shower. You can remove them if they start to peel off but if they remain neat and tidy keep them on for 5 days and up to 2 weeks.

Wear a supportive bra night and day for 6 weeks.

Pain and discomfort can usually be managed with simple painkiller tablets.
Eat healthily and try to exercise a little every day. You might find your movement restricted for a while. The exercises given to you by your breast care nurse will help to minimise stiffness.

If you have any concerns call the team - we would rather know about it and you are never wasting our time! We can always arrange for you to come to the clinic if needed and if you are unwell out of hours you can always attend the emergency department.
Driving
You need to be able to concentrate properly and perform an emergency stop without any distracting pain. You will probably need to avoid driving for 1-2 weeks, but check with your insurance company.
Work
Getting back to work can be necessary or helpful for many women, but you will probably need to wait at least until you get your results and can plan any further surgery or treatment. 
Share by: