- Diagnosis – Paget’s disease of the nipple
- Breast clinic
- No More Illusions
- Defying odds
- Looking on the bright side
- Nipple eczema
- What is nipple eczema?
- Who gets nipple eczema?
- What causes nipple eczema?
- What are the clinical features of nipple eczema?
- What are the complications of nipple eczema?
- How is nipple eczema diagnosed?
- What is the differential diagnosis for nipple eczema?
- What is the treatment for nipple eczema?
- What is the outcome for nipple eczema?
- The ‘Eczema’ That Turned Out to Be Breast Cancer
- Reassurance, Then a More Serious Diagnosis
- My Treatment: A Lumpectomy and Radiation
- Was It Eczema or Something Worse?
- A Double Whammy: Paget’s Disease Plus HER2
- Should Doctors Have Caught Paget’s Earlier?
- Paget’s disease of the nipple
- Breast reconstruction
- Further treatment
Paget’s disease of the nipple
Paget’s disease of the nipple
At the breast clinic you’ll have tests to find out whether you have breast cancer and, if you have, what type of breast cancer.
Staff at the clinic may photograph your breasts to record their current appearance and help identify any further changes that may occur.
Tests you might have at the clinic may include:
- an examination of your breasts to check for lumps or other abnormalities
- a mammogram (if you’re 35 years of age or over)
- an ultrasound scan – which is the first line of investigation used in younger women
- a skin biopsy will be carried out if Paget’s disease is suspected (a punch biopsy of the skin of the nipple and/or areola)
A mammogram is a simple procedure that uses X-rays to create an image of the inside of your breasts. It can identify early changes in your breast tissue when it may be difficult to feel a lump.
Younger women often have denser breasts than older women, which can make identifying changes more difficult. Therefore, mammograms are not as effective in women under 35 years of age. If you’re under 35, your doctor may suggest you have a breast ultrasound instead (see below).
However, if Paget’s disease of the nipple is confirmed, mammography will become an important part of pre-surgery assessment.
During a mammogram, the radiographer will position 1 of your breasts on a flat X-ray plate. A second X-ray plate will press down on your breast from above, temporarily compressing and flattening it between the 2 plates.
An X-ray will be taken, which will give a clear image of the inside of your breast. The procedure will then be carried out on your other breast.
Having a mammogram can be slightly uncomfortable or even painful, but it only takes a few minutes. The image that’s produced will be looked at by 2 people, called film readers, image readers or radiologists, for signs of cancer.
If you’re under 35 years of age, a breast ultrasound may be recommended. This is because your breast tissue may be too dense for a mammogram. Your doctor may also suggest a breast ultrasound if they need to find out whether a lump in your breast is solid or contains liquid.
Ultrasound uses high-frequency sound waves to produce an image of the inside of your breasts. An ultrasound probe or sensor will be placed over your breasts to create an image on a screen. The image will show any lumps or abnormalities that are present.
A skin biopsy is often used to confirm a diagnosis of Paget’s disease of the nipple. A small tissue sample will be taken from your nipple or the skin around it. The sample will be examined under a microscope and tested to see if it’s cancerous.
Paget’s disease of the breast is misdiagnosed due to the fact that it presents itself in a way that resembles eczema. Unless the physician is familiar with the disease, they do not know what to look for. It does not show up on a typical mammogram or ultrasound. It took a breast MRI with contrast for my Paget’s and DCIS to show up. Paget’s is almost always accompanied by a secondary underlying breast cancer. The symptoms of Paget disease of the breast are often mistaken for those of some benign skin conditions, such as dermatitis or eczema (1–3). These symptoms may include the following:
- Itching, tingling, or redness in the nipple and/or areola,
- Flaking, crusty, or thickened skin on or around the nipple,
- A flattened nipple,
- Discharge from the nipple that may be yellowish or bloody.
Because the early symptoms of Paget disease of the breast may suggest a benign skin condition, and because the disease is rare, it may be misdiagnosed at first. People with Paget disease of the breast have often had symptoms for several months before being correctly diagnosed (https://www.cancer.gov/types/breast/paget-breast-fact-sheet). “I was given this journey because God knew I was strong enough to handle it.”
Are you a survivor, spouse, friend, or caretaker with a story to tell? We’d love to hear from you.
No More Illusions
Posted on October 15, 2014
BY Carol Powers
I am a woman living with Stage 1 breast cancer. Even though I am Stage 1, not Stage 4, I know it’s possible that I very well might metastasize someday.
My loss, along with my breasts, my hair, 24 lymph nodes and the free use of my arms for the rest of my life because of lymphedema, is the loss of the illusions of control and certainty. Before I got breast cancer, I thought if I did everything “right” – arrive in a family with no history of the disease, eat right, keep my weight down, exercise, and avoid HRT, I’d never be the 1 out of 8 women diagnosed with breast cancer.
I was wrong. It didn’t matter.
I was aware. I went for my mammogram every year. I thought if I did, early detection would at least find a tumor if there was one there to be found.
My right nipple’s Paget’s Disease was first diagnosed as an “infection”. In true cancer sneakiness, it first appeared to be responding to the antibiotic I was given to treat it. Fortunately, the surgeon I’d been sent to “just to be on the safe side” insisted I go immediately for a diagnostic mammogram and an ultrasound.
Unfortunately, neither of these tests showed anything amiss in either breast. The radiologist came in and examined my nipple after he had reviewed the test results. He told me, again, that the nipple was only infected.
You can imagine the state of euphoria I was in when I left his office that day. I had had the “Gold Standard” of diagnostic tests, and they both said I was perfectly fine!
But by the time of my surgeon’s follow up appointment eight weeks later, the nipple had exploded into a literally bloody mess. I reluctantly signed the consent forms to have the “infected” nipple and a benign cyst under the nipple removed.
The first shoe dropped. The bloody nipple was Paget’s Disease. Hiding underneath the nipple and the benign cyst was DCIS … and a 1.25 cm Invasive Lobular Carcinoma. My surgeon had not realized this during the surgery so he hadn’t removed any lymph nodes; he hadn’t known he needed to because the results from my diagnostic mammogram and ultrasound said everything was fine.
While I was researching radiation, mastectomy, lymph node surgery, etc, etc, I went for an MRI, because the first set of tests had missed everything in the right breast. The report said my left breast was healthy, “consistent with previous studies.” Naively, I believed the MRI report. After all, it was supposed to be much more accurate than the diagnostic mammogram and ultrasound had been.
I decided to have a double mastectomy anyway. And yes, I heard all the arguments against it — no increased survival, more difficult surgery, increased risks of infection, blah blah blah, yada yada yada. I figured that with 3 cancers in one breast already, my other breast was a ticking time bomb. Not to mention that the best diagnostic tools had missed those cancers.
The other shoe dropped. The “healthy” breast turned out to have a 1.0 cm HER2+++ Invasive Ductal Carcinoma lurking inside it. I had a third surgery to remove lymph nodes on the left side. My oncologist canceled the oncotype testing for the first tumor, because it didn’t matter anymore. There was a HER2+++ tumor to worry about now, and chemo was a given.
All the lymph nodes removed on both sides were clear … so I am Stage 1. Yaaaay, I’m cured, right?!
Wrong again. The more I researched, the more I discovered that Stage 1 is no guarantee that the cancer won’t come back, even after chemo. There is still a 30% chance of metastasis. And I’ve had tumors in both breasts. But there is no way to know if I’m one of the 30% or not. So little is known about how, why, and when some tumors metastasize while other tumors don’t.
Why don’t we know more? Research takes money. Most breast cancer funding goes towards awareness and early detection, not to metastasis research/cure.
I’ve completed my 6 rounds of chemo and I’m finishing up my year of Herceptin. I take my estrogen blocker every day (both tumors were estrogen positive) and my bone pill for osteoporosis weekly. I tell myself I’m doing everything I can do to stop a recurrence or a metastasis from happening.
But the threat of it, after I’ve beaten every other unpleasant odd out there, stays with me like a hovering thundercloud.
I detest the word “survivor”. It implies everything’s over and I don’t have to think about cancer, or concern myself with it anymore. The very fact I have to keep on taking an estrogen blocker for at least 5 years is pretty darn good evidence to the contrary, wouldn’t you say?
So you can keep your pink ribbon. You never know if you, or a member of your family, female or male, because men get breast cancer too, will be diagnosed with it. You don’t know if you, or someone you love, will end up being one of the 30% who will die from it, no matter what Stage they were when they were first diagnosed. Because THERE IS NO CURE FOR BREAST CANCER. And until there is more funding for metastasis research to include prevention of metastasis, there most likely won’t be. Awareness, early detection, and a million pink ribbons won’t change that.
Carol A. Powers retired from the Air Force Reserves and the Florida Bar after spending 25 years as a JAG (attorney) both on active duty (1987-1991) and as a reservist (1991 -2012). Her assignments included living stateside and overseas (UK and Spain), providing legal services and advice in the areas of military justice and civil law to Air Force commanders, airmen, and their family members. Carol and her husband Steve, a retired Air Force maintenance officer, live in North Carolina, with their son, Zachery, a high school senior, who they homeschool, and 2 cats. When she isn’t reading or baking (her 2 favorite hobbies), she’s working on a memoir, “It Started With A Squirt,” about her experiences with breast cancer, along with writing a time travel novel that has nothing whatever to do with breast cancer.
Cynthia and her two boys
“My work day just ended when I received the call from my doctor,” says Cynthia. “He gave me the terrible news that I had breast cancer and my first thought was ‘what about my kids?’”
Cynthia, a loving wife and mother to two incredible boys, ages 5 and 6, was diagnosed with Paget’s Breast Cancer in October 2017. This is a rare form of cancer that only affects 1-4% of all breast cancer cases. After genetics testing and more life-altering factors, Cynthia underwent a bilateral mastectomy.
“I told my kids that I was going to have surgery to remove toxic stuff from my body and that I might not be myself for a while,” Cynthia says. “It took them a few days to get use to my bald head, but soon after, it didn’t phase them.”
“My family had never been touched by cancer before,” says Cynthia. “I’m the first born of my generation and the first to experience this terrible disease.”
Prior to her diagnosis, Cynthia recently started a new job and was going to school for her Bachelor’s Degree in Social Work. Sadly, due to her multiple surgeries and treatment plan, she had to stop both. Her husband was also unable to work overtime as he became the primary caretaker for Cynthia and their kids. The lack of income and increase in medical bills quickly took a toll on the family.
“No one is prepared for cancer. I was terrified to take time off. Since I had just started my new job, I didn’t qualify for FMLA right away,” says Cynthia. “We immediately felt the financial burdens of cancer.”
Looking on the bright side
Thanks to our generous community, we provided Cynthia and her family with a grant to cover their mortgage. This allowed the family to stay in their home and gave Cynthia time to heal.
Last month, Cynthia had breast reconstruction surgery and still receives treatment every three weeks. She feels less worrisome as she tries to regain a sense of normalcy in her life.
“I was fortunate to have found Family Reach and the grant they gave us helped to keep our family afloat. I’m trying to set goals and get back to my old routine. I don’t take life for granted anymore. I hope one day it will all be okay again,” she concludes.
If you wish to make a tangible difference in the live’s of families like Cynthia’s, you can. Donate here.
What is nipple eczema?
Nipple eczema is a localised dermatitis involving the nipple and areola and is characterised by erythema and scaling. It may be itchy and painful. Nipple eczema can be a local manifestation of atopic dermatitis/eczema when it arises with classic age-related patterns of eczema on other body sites, or it can occur in isolation.
Who gets nipple eczema?
Nipple eczema can occur in anyone as a solitary condition; however, it often occurs in patients with current or past eczema elsewhere. Nipple eczema is mostly diagnosed in teenage girls, regardless of any prior history of atopic dermatitis, but it can also affect infants, children, and older men and women. Nipple eczema may occasionally affect non-atopic breastfeeding women .
What causes nipple eczema?
A genetic predisposition and environmental triggers cause nipple eczema. It occurs in the context of different types of dermatitis, mainly, atopic dermatitis, irritant contact dermatitis, and allergic contact dermatitis.
- Patients with atopic dermatitis have a higher likelihood of developing nipple eczema. An underlying defect in the skin’s barrier function increases sensitisation and leads to a dysregulated immune response to specific antigens (see causes of atopic dermatitis) .
- Irritant contact dermatitis results from irritation by various topical agents, soap, washing detergent, clothing, and fragrances.
- Allergic contact dermatitis is due to a delayed hypersensitivity reaction to contact allergens. The allergen may be an ingredient in a topical agent used on the nipple (eg, fragrance, preservative, lanolin or vitamin E), a topical therapeutic (eg, an antibiotic cream), a botanical (eg, chamomile, aloe vera, or tea tree oil), or a metal (eg, ;nickel associated with body piercing) .
What are the clinical features of nipple eczema?
Nipple eczema most commonly affects the skin of one or both areolae, but the part of the areola at the base of the nipple and the nipple itself are usually spared. Nipple eczema rarely extends into the periareolar skin (around the areola) or to the rest of the breasts.
Acute nipple eczema can present with erythematous papules and plaques, with vesicles, oozing, crusting, or erosions. Chronic nipple eczema has a dry, scaly appearance, with lichenification on an erythematous or hyperpigmented base. Nipple eczema is often itchy and painful, especially in breastfeeding women .
What are the complications of nipple eczema?
Secondary bacterial infection may occur, due to fissures and the compromised skin integrity in nipple eczema. Colonisation with Staphylococcus aureus can be further complicated with mastitis or breast abscess if not treated promptly.
Other complications include the rare side effects associated with the therapeutic agents used for nipple eczema, such as atrophy from the excessive use of potent corticosteroids or folliculitis from an occlusive emollient .
How is nipple eczema diagnosed?
The diagnosis of nipple eczema is made clinically. Occasionally, other tests may be required.
- Patch tests may identify causative antigens in allergic contact dermatitis.
- Mycology (microscopy after application of potassium hydroxide and culture of skin scrapings of the affected area) is warranted if there is an active scaly edge to the lesion or maceration and can help rule out tinea or candida infection of the breast.
- Swabs may be taken for culture to identify any secondary bacterial infection, which may delay response to treatment.
- Skin biopsy can be performed to exclude Paget disease, especially in a unilateral disorder of the nipple in an older patient .
What is the differential diagnosis for nipple eczema?
Other conditions that should be considered in a patient with nipple eczema include:
- Allergic contact dermatitis
- Bacterial infection (eg, cellulitis, impetigo, or mastitis)
- Fungal infection
- Other inflammatory skin diseases, mainly psoriasis
- Mammary Paget disease .
A diagnosis of allergic contact dermatitis should be considered if there is a minimal response to conventional treatment methods for nipple eczema, especially in patients with bilateral lesions extending beyond the areola. Mammary Paget disease, a slow-growing cutaneous form of intraductal carcinoma, should be ruled out in an adult with a unilateral and chronic eczematous lesion of the nipple persisting for more than three months that has not improved after using a topical steroid.
Other rarer conditions that may be mistaken for nipple eczema include erosive adenomatosis, psoriasis, Hailey–Hailey disease, and pemphigus. Skin cancers (eg, intraepidermal squamous cell carcinoma, basal cell carcinoma, and malignant melanoma) should be ruled out when there is a reasonable degree of suspicion .
What is the treatment for nipple eczema?
The multifactorial causes of nipple eczema should be addressed. The prevention of recurrence is key, and patients should be encouraged to avoid precipitating irritants and allergens where these are known. Routine skin care should include moisturisers, as these will help restore the skin’s normal barrier function and reduce pain and itch .
Topical corticosteroids (especially in ointment formulation) are the mainstay of treatment for most cases of nipple eczema. They work well and are easily absorbed by the thin areolar skin.
- Moderate potency topical steroids are used for a severe or recalcitrant presentation.
- Low potency steroids are suitable for mild eczema or maintenance therapy following treatment with a moderate potency steroid .
In breastfeeding women with nipple eczema, topical steroids should be applied after breastfeeding the infant. Before nursing, these should be then wiped off to avoid potential steroid-related adverse effects by expressing breast milk from the breast and using it to wipe off the steroid ointment; the fat contained in the milk may help retain moisture in the nipple and minimise dryness.
Systemic steroids are rarely necessary for eczema confined to the nipple or the skin of the breast.
Topical calcineurin inhibitors (eg, tacrolimus and pimecrolimus) are also useful, but there is little information in the literature about the potential side effects on the breastfed infant.
Secondary bacterial skin infection (S. aureus) should be treated with antibiotics. Systemic antibiotics have shown better eradication of infection compared to topical antibiotics; they are also less likely to induce methicillin-resistant bacteria and are less likely to result in antibiotic allergy .
Pain or burning discomfort of the nipples can be relieved by taking paracetamol; this is generally safe in a breastfeeding mother .
What is the outcome for nipple eczema?
Nipple eczema tends to run a chronic course with varying degrees of relapse and remission. The aim is to prevent exacerbations by identifying and avoiding precipitating factors.
Patients should be educated on basic skin care. Mild nipple eczema can generally be well-controlled with the avoidance of soap, the application of liberal emollients, and the intermittent application of a topical steroid when the eczema is active .
The ‘Eczema’ That Turned Out to Be Breast Cancer
By Kiflin Minckler, Special to Everyday Health
A few years ago, the company I work for started a program called Operation Save-a-Life. In order to keep their medical insurance, employees and their spouses had to have certain mandatory medical tests on a regular basis, one of which was a routine mammogram.
When I went for my mammogram, on October 11, 2011, I was a little surprised when the technician came back to the waiting room and said, “I need to take a few more slides. There are some calcifications in the pictures and the doctor will, I’m sure, want more views.”
As soon as I got home, I Googled “calcifications in a mammogram.”
What I read on Breastcancer.org was a little disconcerting: “As old cancer cells die off and pile up, tiny specks of calcium (called ‘calcifications’ or ‘microcalcifications’) form within the broken-down cells. The mammogram will show the cancer cells inside the ducts as a cluster of these microcalcifications, which appear either as white specks or as a shadow.”
I waited for the call about my mammogram results. “The doctor wants you to have a biopsy,” said the voice on the phone. After the biopsy, I was off to Dallas for a business meeting.
Reassurance, Then a More Serious Diagnosis
On day two of our annual managers’ meeting, I looked down at my cellphone and noticed a missed call from my doctor’s office. I listened to my voicemail.
It was my doctor’s voice.
He never calls — it’s always his nurse.
“You have something called DCIS (ductal carcinoma in situ),” he told me, “which is the presence of abnormal cells inside a milk duct in the breast. It’s the earliest form of breast cancer. We’re very lucky we caught it in the very early stages. It’s not a death sentence, don’t be afraid.”
His words were soothing, and I was calm again. I scheduled an appointment with a local surgeon. He looked over my reports, and then looked up and said, “You have what is known as DCIS with microinvasion,” meaning the cancer has spread to nearby tissue. That’s the earliest stage of malignant invasion.
“Microinvasion? They told me it was contained in the milk duct!” I said. “I think I want to go to someone who specializes in breast cancer.”
The surgeon said that it was my choice, and I left his office.
My Treatment: A Lumpectomy and Radiation
I researched hospitals in Boston and found the Massachusetts General Hospital Center for Breast Cancer. They were very reassuring and told me they would have a team of doctors who would follow my case and determine the best course of action. I felt confident I had made a good choice.
By now, it was early November 2011. I had a lumpectomy, and when the pathology report came back, they told me I had grade 3 cancer.
I learned that tumors are graded as 1, 2, 3, or 4, depending on the amount of abnormality. In grade 1, the tumor cells appear close to normal. Grade 1 breast tumors tend to grow and spread slowly.
Grade 3 and 4 tumors don’t look like normal cells and tissue, and they tend to grow rapidly and spread faster than lower-grade tumors.
My medical team decided that because the cancer was mostly contained to my milk ducts with only microinvasion, and because they felt they had gotten everything with the surgery, I should just have radiation.
I had seven weeks of radiation and went faithfully to every checkup and every mammogram.
In 2012, all was good.
In 2013, all was good.
Was It Eczema or Something Worse?
Then in February 2014, I was taking a shower and noticed a tiny bit of crust on my left nipple. I scraped it off with my thumbnail. A few weeks later it was back, and when it came back the third time, I became concerned.
My regular doctor was booked, so I saw another doctor who did a very thorough breast exam. She told me the crust appeared to be a little bit of eczema, and not to worry.
I had my regularly scheduled body scan with my dermatologist in midsummer and mentioned the crust on my nipple. “It could be eczema,” she said, “but did the doctor prove it to you? With your history, you have to be your own health advocate. Never settle with just their opinion. You need proof.”
I had already scheduled my annual appointment at Mass General. “If they don’t prove to you that it’s eczema, call me back and I’ll do a biopsy,” my dermatologist said.
My doctor at Mass General confirmed that it was probably just eczema. My mammogram and breast exam showed nothing abnormal — so I was to come back in a year.
But by the end of December, I was having intermittent pain in my nipple — a hot, burning pain, like a hot poker.
I Googled the symptom and came up with something called Paget’s disease of the nipple.
A Double Whammy: Paget’s Disease Plus HER2
I immediately called my dermatologist and asked if she would do a biopsy.
She called me within days: “You have Paget’s disease,” she told me.
Here’s what I learned about Paget’s disease:
- It’s a rare type of cancer that forms in or around the nipple and accounts for about 1 percent of all breast cancers. The cause is unknown.
- People with Paget’s disease of the nipple may also have an underlying breast cancer.
- Early symptoms may include redness or crusting of the nipple skin. Later symptoms often include tingling, itching, increased sensitivity, burning, or pain in the nipple.
- Mastectomy is the usual treatment
On February 9, 2015, one year after my first symptom, I had a left breast mastectomy with no reconstruction. Because I had a prior cancer and radiation that caused skin damage, my skin was too fragile to be stretched, and they had to remove my nipple and surrounding skin. There were other options, but they posed too many other risks, so I decided to just do nothing.
On my follow-up visit, they told me that I not only had Paget’s disease — I also had cancer in my milk ducts again.
It was something called HER2-positive breast cancer; about one in every five breast cancers has this gene mutation. HER2-positive breast cancers tend to be more aggressive than other types of breast cancer, and they’re also less likely to be sensitive to hormone therapy.
A few years ago, HER2-positive breast cancer was pretty much a death sentence. But with new therapies, the chances for survival are much better. Unlike the BRCA gene, which can be passed on to your descendants, HER2 is not hereditary, and I cannot pass it down to my daughter. The HER2 gene is only present in breast cancer cells, not in the rest of the body.
My doctor recommended a medication called raloxifene, which is used in women at high risk for invasive breast cancer. It doesn’t work on everyone, but it can lower the odds that breast cancer will come back.
I asked what my chances of recurrence were, and the doctor said, “Honestly, I don’t know, but if I were a betting man I would say around a 20 percent chance.”
If I were playing the lottery, I would like those odds. But when you’re playing Russian roulette, they don’t seem as good.
Should Doctors Have Caught Paget’s Earlier?
I had one more question: How could I have slipped through the cracks and gotten a clean bill of health not only from my local clinic, but also from a breast cancer center of a leading U.S. hospital?
In all of my online research, I read over and over again that Paget’s disease is almost always misdiagnosed as eczema or dermatitis. That said, wouldn’t you think that doctors should suspect it when you have those symptoms?
The doctor’s reply: It’s so very rare that they weren’t looking for it, nor did they suspect it.
So I suggest that everyone follow the advice my dermatologist gave me: You know your body better than anyone else. Be your own health advocate. Don’t settle for your doctor’s opinion; make them prove the diagnosis.
Kiflin Minckler will be 63 in December. She’s married and lives in Winchendon, Massachusetts, and has two children and five grandchildren ranging in age from 9 to 27. She’s worked in the propane industry for 31 years and is a district manager at AmeriGas Propane. She loves the outdoors and especially enjoys spending time with her grandkids.
Paget’s disease of the nipple
If you’re diagnosed with Paget’s disease, surgery is often the first form of treatment you will receive. There are two main types of surgery. They are:
- mastectomy – surgery to remove the whole breast, which can be followed by reconstructive surgery to recreate the removed breast
- breast-conserving surgery – surgery to remove the cancerous lump (tumour) in your breast
These types of surgery will also involve removing your nipple and the darker area of skin surrounding it (the areola).
The two different types of surgery are discussed in more detail below.
A mastectomy removes all your breast tissue, including your nipple. You may need to have a mastectomy if:
- the tumour is large or in the centre of your breast
- there is more than one area of breast cancer
- breast-conserving surgery (see below) is not able to provide acceptable results
If lymph nodes (small glands) are removed from your armpit during a mastectomy, the scarring may block the filtering action of the lymph nodes, resulting in a condition called lymphoedema. This is a long-term condition, but can be treated with:
- compression sleeves – tightly fitting bandages that push excess fluid out of your arm
Lymphoedema can develop months or sometimes years after surgery. See your breast care nurse or GP if you notice any swelling in your arm or hand on the side of your operation.
Breast-conserving surgery aims to save as much of your breast as possible while removing the cancer with a rim of healthy tissue.
If you have Paget’s disease, your nipple and areola will be removed. You should be offered reconstructive surgery to improve the appearance of your breast after surgery (see below).
If you have breast-conserving surgery, the amount of breast tissue removed will depend on:
- the size of the tumour in relation to the size of your breast
- whether the tumour is in one place or scattered throughout your breast
Your surgeon will remove an area of healthy breast tissue around the cancer so it can be tested for traces of cancer.
If cancer cells are found in the surrounding tissue, you may need to have more tissue surgically removed from your breast.
After having breast-conserving surgery, it’s likely you will need radiation treatment (radiotherapy) to destroy any remaining cancer cells.
If you have a mastectomy, you may be able to have reconstructive surgery to recreate your breast. This can be done by:
- inserting a breast implant
- using tissue from another part of your body to create a new breast
The reconstruction can be carried out at the time of your mastectomy or at a later stage. You should discuss your options fully with your surgeon and breast nurse before making a decision.
For example, it may be possible to have reconstructive surgery after breast-conserving surgery to improve the appearance of your breast and create a nipple.
Creating a nipple
A nipple can be created by:
- having a nipple tattooed onto the skin
- using your own body tissue, such as tissue from your other nipple, although around half of these flatten out and shrink over time
- using a stick-on latex (rubber) nipple, which can be made from a mould of your other nipple so that they are identical; you stick it on every day with glue and it can be removed for washing
If you decide not to have breast reconstruction, you can wear a false breast or breast prosthesis, which are available free on the NHS.
After having a mastectomy, you may have a temporary, fibre-filled prosthesis and a permanent prosthesis made from silicone, which can be replaced every two years.
After your surgery, you may need further treatment if you have invasive breast cancer, where the cancerous cells have spread into other tissue in your breast.
If you had non-invasive breast cancer, where the breast cancer cells were contained in one area of your breast, surgery may be all the treatment you need.
Other types of treatment for breast cancer include:
- chemotherapy – cytotoxic medication that prevents cancer cells from dividing and growing is used to destroy cancer cells
- radiotherapy – where controlled doses of high-energy radiation, usually X-rays, are used to destroy cancer cells
- biological therapy – if your breast cancer is HER2 positive, biological therapy, usually a medication called trastuzumab, can be used to treat the cancer by stopping the effects of HER2 and helping your immune system fight off cancer cells
- hormone therapy – if your breast cancer is hormone-receptor positive, hormone therapy can be used to treat the cancer by lowering the levels of hormones in your body or stopping their effects