Surgery for breast cancer in men

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1 Surgery for breast cancer in men This information is an extract from the booklet Understanding breast cancer in men. You may find the full booklet helpful. We can send you a free copy see page 9. Contents Surgery Before your operation After your operation Going home Surgery Most men only have a small amount of breast tissue, so the most common operation involves taking away all of the breast tissue and the nipple. This is called a mastectomy. You will usually have some or all of the lymph nodes removed from the armpit during this operation. Occasionally the surgeon may be able to remove only the area of the cancer with some surrounding normal-looking tissue. This operation is called a wide local excision and for some men it may mean that they keep their nipple. I had a mastectomy and my lymph nodes tested. I didn t have a reconstruction. I was left with a six-inch scar across my chest. Herbie Questions about cancer? Ask Macmillan Page 1 of 9

2 After this operation, the pathologist examines the tissue that s been removed to see if there is an area of normal cells around the cancer. This is called a clear margin. If there are still cancer cells at the edge of the removed breast tissue, you ll need to have a mastectomy. Before your operation, your surgeon will talk to you about the type of operation that is recommended for you. I have a scar across my chest but I don t worry about it. My chest hair has grown over it so I m not very self conscious. Herbie Surgery to the lymph nodes Your surgeon may remove some or all of the lymph nodes in your armpit. There are different types of lymph node surgery. Sentinel lymph node biopsy (SLNB) This may be done if you have a small cancer and the ultrasound of your armpit is normal. SLNB isn t suitable for everyone your surgeon will explain if it s an option for you. A sentinel lymph node biopsy is a way of checking the smallest possible number of lymph nodes (usually 1 3) in the armpit to see if they contain cancer cells. The sentinel nodes are the first ones that lymph fluid drains to from the breast, so they are the most likely to contain any cancer cells. If the sentinel nodes don t contain cancer cells, you won t need surgery to remove more lymph nodes. Removing only the sentinel lymph nodes lessens the risk of side effects that can sometimes occur after lymph node surgery. These include swelling of the arm known as lymphoedema and stiffness of the arm (see page 8). Page 2 of 9 Questions about cancer? Ask Macmillan

3 How an SLNB is done The doctor or a technician will inject a tiny amount of radioactive liquid, which is harmless, into your breast, usually around the nipple. You have this done on the day of surgery or sometimes the day before. During the operation, the surgeon may inject a blue dye into your breast, which stains the lymph nodes blue. The sentinel lymph nodes absorb the radioactivity or become blue first. The surgeon uses a small handheld instrument to find the lymph nodes that have picked up the radioactivity. They only remove the blue or radioactive nodes (sentinel nodes). These are tested to see if they contain cancer cells. If any of the nodes contain cancer cells, you may have further surgery to remove all the lymph nodes (axillary lymph node dissection). Some men may have radiotherapy to the lymph nodes instead of surgery. Removing all the lymph nodes In some cases, the surgeon will want to remove all the lymph nodes in the armpit. This is called an axillary lymph node dissection (ALND) or clearance. It removes any nodes that contain cancer cells. You usually won t need radiotherapy to the area afterwards. An ALND is usually done when: the ultrasound of the lymph nodes is abnormal, and a biopsy of the lymph nodes is positive, or the sentinel node biopsy shows there are cancer cells in the nodes. There s an increased risk of developing swelling of the arm called lymphoedema after an ALND. We have more information about lymphoedema and taking care of your arm that we can send you. Questions about cancer? Ask Macmillan Page 3 of 9

4 Before your operation Before your operation, you may be seen at a pre-assessment clinic. This gives you a chance to ask questions and talk over any concerns about the operation. You may have tests to check your general health. These can include blood tests, a chest x-ray or a recording of your heart (ECG). Your surgeon or breast care nurse will talk to you about how your chest will look after your surgery. They may show you photographs of other men who have had breast surgery or put you in touch with someone who has been through it. Or you can contact a support group or Breast Cancer Care on You will usually come into hospital on the day of your operation. You ll meet the doctor who gives you the anaesthetic (anaesthetist). The nurses may give you elastic stockings (TED stockings) to wear during and after the operation to help prevent blood clots. After your operation You ll be encouraged to start moving around as soon as possible after your operation. Your wound You ll have a dressing covering your wound, which may be left undisturbed for the first couple of days. The nurses will let you know how to look after it before you go home. How long your wound takes to heal depends on the operation you had. If you only had a small area of tissue removed, it will usually heal quickly. If you don t have stitches that dissolve, you will probably have your stitches removed about 7 10 days after your operation. Wound infection This can be a complication of surgery. Signs of infection can include warmth, redness, swelling around the wound or discharge coming from it. You may also feel unwell with a fever. Tell your nurse or doctor if you get any of these symptoms, even after you go home. Page 4 of 9 Questions about cancer? Ask Macmillan

5 Pain You ll probably have some pain around the wound and in your armpit if you had lymph nodes removed. This may last a few days. The nurses will give you painkillers to take regularly until it settles down. After a mastectomy, you may need to take them for a week or two. Let your doctor or nurse know if the painkillers aren t helping. They can prescribe stronger ones for you to try. Drains You may have a long, thin plastic drainage tube coming from your wound. This is attached to a bottle that fluid from the wound drains into. It s usually left in for 24 hours or until it stops draining, which may take a few days. You can go home with the drain. A district nurse or practice nurse may check it and remove it when you re at home. Or you may come back to have it removed at the hospital. Fluid collecting around the wound (seroma) Fluid can build up in the area around the wound. This is called a seroma. It usually goes away within a few weeks. Sometimes your nurse or doctor may drain it off with a needle and syringe. Stiff shoulder or arm After a mastectomy or having lymph nodes removed, your shoulder or arm may feel stiff or sore. It s important to do the arm exercises that your physiotherapist or nurse shows you. This will help improve the movement in your shoulder or arm and reduce the risk of long-term problems. You should start the exercises the day after your operation and gradually build up what you can do. Breast Cancer Care have a leaflet about these exercises. You can call them on Numbness and tingling in the upper arm You may have numbness and tingling if nerves have been injured during the operation. This is more likely if you had all the lymph nodes in the armpit removed. It may slowly improve over several months but is sometimes permanent. Questions about cancer? Ask Macmillan Page 5 of 9

6 How your chest looks It is common to have swelling and bruising after your operation. This should improve after a few weeks, but let your nurse know if it doesn t. If you had a SLNB, the dye may make your skin in that area look blue for a while, but this is normal. After breast surgery there will be a scar across your chest in line with where your nipple used to be. There may also be a dent where the breast tissue has been removed. To begin with, your scar may be red if you have white skin, or darker if you have dark skin. It may also be firm and slightly raised. Over time, it will flatten and fade. Everyone s skin heals differently. If you have dark skin or fair, freckled skin, scars can take longer to settle and may be more noticeable for longer. For some men this won t be a problem at all. But, it can affect your confidence and how you feel about yourself as a man. If you are worried about changes in your appearance, talk to your breast care nurse or surgeon. You may worry that your partner will be put off by your scars or a change in how your body looks. If you re feeling selfconscious about how you look, talking with your partner or specialist nurse can help you feel more confident. Reconstruction of the breast area is not commonly carried out for men as implants don t give the right shape for men. But it may be possible to improve the appearance of the chest area with surgery. Your surgeon or breast care nurse can also discuss with you ways of recreating the appearance of a nipple. Page 6 of 9 Questions about cancer? Ask Macmillan

7 Going home Most men will go home on the day of their surgery or the day after. When you get home, take things easy for a while. How you feel depends on the operation you ve had. It s common to feel very tired, so try to have plenty of rest and eat well. Although you might feel you have recovered physically, you may continue to feel emotionally tired. You may need to avoid lifting or carrying anything heavy for a few weeks. It s important to carry on with the exercises you were shown in hospital. Try to do a bit more each day and rest in between so that you build up the amount that you do gradually. Some insurance policies give specific time limits for not driving after surgery so check this with your insurance company. Don t drive unless you feel in full control of the car. Before you leave hospital, you ll be given an appointment to attend the outpatient clinic to see the surgeon and breast care nurse. At the clinic they will check that the wound is healing properly. They ll also tell you the stage of the cancer. The stage describes the size of a cancer and if it has spread from where it started. Your doctors will discuss with you any further treatment that you may need. This is a good time for you to ask questions or talk to them about any problems you have. Questions about cancer? Ask Macmillan Page 7 of 9

8 Late effects of surgery Some men may have problems with the effects of surgery for some months or longer after their operation. Tell your breast care nurse if you have any of these or if there s anything you are worried about. Cording This is an uncomfortable feeling like a tight cord running from the armpit to your hand. This is called cording. It can happen weeks or months after surgery and usually gets better over a few months. You may need physiotherapy and massage to improve it. Pain and changes in sensation Rarely some men have numbness, tingling or pain in the upper arm, because the nerves have been affected by surgery. Your doctor can prescribe low doses of antidepressant drugs and anticonvulsants (drugs to stop fits) to improve these symptoms. They help to reduce the pain caused by nerve damage. Changes to your arm/shoulder movement Arm and shoulder movement and strength usually improve after surgery. Doing your exercises helps reduce the risk of long-term problems. If you have problems, ask your doctor for a referral to a physiotherapist. If moving your shoulder or arm is painful, your doctor can prescribe you some painkillers. Lymphoedema Surgery or radiotherapy to the lymph nodes in the armpit can sometimes lead to a swelling of the arm called lymphoedema. If you notice any swelling, speak to your breast care nurse or doctor. The earlier the treatment for lymphoedema begins, the more effective it can be. We have information on how to help reduce your risk of getting lymphoedema that we can send to you. Our booklets Managing the late effects of breast cancer has more information. Page 8 of 9 Questions about cancer? Ask Macmillan

9 More information and support More than one in three of us will get cancer. For most of us it will be the toughest fight we ever face. And the feelings of isolation and loneliness that so many people experience make it even harder. But you don t have to go through it alone. The Macmillan team is with you every step of the way. To order a copy of Understanding breast cancer in men or any other cancer information, visit be.macmillan.org. uk or call We make every effort to ensure that the information we provide is accurate and up to date but it should not be relied upon as a substitute for specialist professional advice tailored to your situation. So far as is permitted by law, Macmillan does not accept liability in relation to the use of any information contained in this publication, or thirdparty information or websites included or referred to in it. Macmillan Cancer Support Registered charity in England and Wales (261017), Scotland (SC039907) and the Isle of Man (604). Registered office 89 Albert Embankment, London, SE1 7UQ REVISED IN JUNE 2015 Planned review in 2017 Questions about cancer? Ask Macmillan Page 9 of 9

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