Surgical techniques in breast cancer

Abstract

Surgery forms a key part of the contemporary treatment of breast cancer. Techniques for the surgical management of breast cancer continue to evolve, and in current practice aim to achieve optimal control of the breast tumour while minimising morbidity to the patient and achieving the best possible aesthetic and quality of life outcomes. Research into specific surgical techniques with these aims was carried out in several hospitals and universities across the United Kingdom. This research focused on two specific areas: sentinel lymph node biopsy (SLNB) in breast cancer, and reconstructive surgery following mastectomy. Feasibility studies were carried out evaluating different techniques for SLNB, examining the role of routine lymphoscintigraphy in SLNB, and the use of SLNB in screen-detected impalpable breast cancer. Immunohistochemical studies were carried out to provide further validation data in support of the sentinel node hypothesis. These studies have informed both clinical practice and the design of subsequent research studies in SLNB. In breast reconstruction, scientific data regarding reconstruction techniques and oncological effects of reconstruction were evaluated, and the issues surrounding the management of breast cancer in the previously augmented breast were assessed. Outcomes in a large series of immediate breast reconstructions utilizing a novel surgical technique were reported, demonstrating that this was a safe and effective technique for immediate reconstruction in both the settings of risk-reducing mastectomy and therapeutic mastectomy for the treatment of breast cancer. Finally, validation data in support of a potential new visualisation tool (stereophotogrammetry) for the objective assessment of aesthetic outcomes in breast reconstruction surgery were described. The work has made a significant contribution to knowledge in both of these fields.

Date of Award	May 2014
Original language	English
Supervisor	John Winder (Supervisor), Ciara Hughes (Supervisor) & Richard Wilson (Supervisor)