After all the information and preparation for your surgery it is very normal to expect some insecurity anxiety and emotional swings. Relax, this is completely normal. Most other patients have similar feelings. Talking to either of the surgeons involved will allow you to verbalise this and to be re-assured about what are perfectly reasonable concerns.
After preliminary tests and perhaps a visit to the Physician in order to make sure any medical conditions you may have are optimally controlled a date will be set for theatre. Prepare yourself for a stay of 3 – 5 days if no flap surgery is to be done and 5 – 7 days with flaps.
On the day of admission most of our patients will go to the x ray department for some form of imaging to ensure optimal surgical outcome. These may include mammogram type hook wire localization of the tumour, sonar, plan x rays and scans of the armpit to identify potential lymph glands which we may need to sample during the operation. After this you will be returned to the ward and be prepared for theatre.
Access to specialized breast care should be available to all women, regardless of their socioeconomic circumstances. There are three specialized breast care centres with open access clinics in the Johannesburg area.
Charlotte Maxeke Breast Clinic
Charlotte Maxeke Johannesburg Academic Hospital
Breast Clinic on a Friday (area 348)
Batho Pele Breast Unit
Chris Hani Baragwanath Academic Hospital
Breast clinic on a Wednesday
Helen Joseph Breast Care Clinic
Helen Joseph Hospital
Auckland Park, Johannesburg
Clinic for new patients on a Wednesday
Not everyone who gets diagnosed with Breast Cancer will need chemotherapy. The decision regarding chemotherapy is based on the biology of the cancer, and your Oncologist will discuss this with you. This includes assessment of the Endocrine Receptor Status, Her 2 status and KI 67, the so called ‘IHC4”, based on the pathology report.
Depending on your specific case the Oncologist may request a genomic profiling of your specific cancer. This assesses a number of genes(these differ according to the test used) to assess the risk of the cancer coming back with and without chemotherapy. This is like the “signature” of the cancer. There are different tests like the Oncotype DX or Mammaprint that are available for this indication.
A “one size fits all” approach is no longer appropriate. The treatment will be individualised according to your specific cancer, and your unique situation.
Looking at all cancers, approximately 60% of patients will need radiation therapy at some time during the course of their illness.
In patients with breast cancer radiation therapy is required if you have had a lumpectomy or local excision of the cancer alone, if your oncologist feels that you are at risk for a local recurrence of the cancer after mastectomy and for palliation of symptoms such as pain or uncontrolled growth of the cancer.
Patients who have had a mastectomy will need radiation therapy if their growth was large (more than 5cm), incompletely cut out or there were nodes involved under the arm as these factors make the risk of a local recurrence on the chest wall higher.
The risk of recurrence can be significantly reduced by the addition of radiation therapy.