Breast surgery

Surgery for cancer and benign lesions, reconstruction, prevention for women at risk, and follow-up after treatment.

Oncological breast surgery

Removing the tumour while preserving as much of the breast as possible: lumpectomy or mastectomy, and assessment of the lymph nodes in the armpit.

See the operations

Breast reconstruction

Immediate or delayed, planned with the plastic surgeons; Dr Monnier takes part in these operations.

Oncoplastic surgery

Removing the cancer with a safety margin while preserving the shape of the breast as far as possible, using plastic surgery techniques — sometimes making it possible to avoid a mastectomy.

Benign lesions

Fibroadenomas, cysts, “B3” lesions: confirming the diagnosis, then monitoring or removing the lesion depending on the situation.

See “Benign lesions”

Risk-reducing surgery

For women carrying a predisposing mutation, such as BRCA1, BRCA2 or PALB2, or at high hereditary risk: enhanced surveillance or risk-reducing mastectomy, depending on the gene and the level of risk.

Follow-up after treatment

Clinical and radiological monitoring, sequelae and treatment-induced menopause, psychological support: coordinated follow-up over the long term.

Genetic assessment

Coordinated with the cancer geneticists for patients at hereditary risk; it guides surveillance or preventive surgery, and may also concern your relatives.

Personalised screening and genetic counselling

The operations

Lumpectomy (breast-conserving surgery)

What it involves — Removing the tumour with a margin of healthy tissue, while keeping the breast.

When it is offered — When the size of the tumour, relative to the size of the breast, allows it. It is most often followed by radiotherapy.

Breast-conserving surgery, step by step

Localisation

If the tumour cannot be felt, a metal guide wire is placed in the lesion before the operation, under radiological guidance. It guides the removal.

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Mastectomy

What it involves — Removing the breast tissue. Depending on the case, the skin and nipple may be preserved, particularly when immediate reconstruction is planned.

When it is offered — When the tumour is extensive or present in several parts of the breast, when breast-conserving surgery would not give a good result, or according to the patient’s choice.

Mastectomy without reconstruction, step by step

The incision

It forms a horizontal or slightly oblique ellipse around the areola, designed so that the remaining skin closes flat, without excess.

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Mastectomy with immediate reconstruction, step by step

The areola and nipple are

The incision

It is placed where it will be least visible, most often in the fold under the breast or on the side. The areola and nipple stay in place.

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Sentinel lymph node biopsy

What it involves — Locating and removing the first lymph node or nodes in the armpit that drain the breast, to find out whether the cancer has spread to them.

When it is offered — For most invasive cancers, when the lymph nodes do not appear to be affected before surgery. It is most often performed during the same operation as the breast surgery.

The sentinel lymph node, step by step

Injecting the tracer

The day before or the day of the operation, a very weakly radioactive substance, the tracer, is injected around the areola.

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Axillary dissection

What it involves — Removing a group of lymph nodes from the armpit.

When it is offered — When involvement of the lymph nodes calls for it. It has become less frequent thanks to the sentinel node technique.

Axillary lymph node dissection, step by step

The incision

It is placed in a fold of the armpit, where it is barely visible once the arm is lowered. During a mastectomy, it sometimes uses the same scar.

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Oncoplastic surgery

What it involves — Removing the cancer with a safety margin and reshaping the breast, in a single operation.

When it is offered — When a simple lumpectomy would leave a visible deformity, because of the size or position of the tumour.

An example: oncoplastic surgery with the reduction technique, step by step

The marking

Before the operation, with you standing, the new shape of the breast and the future position of the areola, higher up, are drawn on the skin. The tumour lies in the area that will be removed.

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Breast reconstruction

What it involves — Recreating a breast after a mastectomy, with an implant or using the patient’s own tissue.

When it is offered — During the same operation as the mastectomy, or later. It is performed with the plastic surgeons; Dr Monnier takes part in these operations.

Implant or your own tissue, seen in profile

Implant in front of the muscle

A silicone gel implant fills the skin envelope. It is placed in front of the pectoral muscle.

The choice depends on your figure, any radiotherapy, your general health and what matters most to you. It is discussed in consultation, with the plastic surgeon.

Risk-reducing mastectomy

What it involves — Removing the breast tissue before a cancer develops, to greatly reduce the risk, without eliminating it completely.

When it is offered — For some women carrying a predisposing genetic mutation or at high hereditary risk, after a genetic counselling consultation and time for reflection. It is most often combined with immediate reconstruction.

Removal of a benign lesion

What it involves — Removing a benign lesion, or a lesion whose nature the biopsy could not establish, to analyse it in full.

When it is offered — When the lesion grows or causes discomfort, or when the diagnosis needs to be confirmed.

All these operations are performed under general anaesthesia. How they are carried out and what follows depend on many factors, which are discussed in consultation.

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