Breast Cancer & Benign Breast Conditions
Dr Clement investigates and manages all breast cancers and benign breast conditions. During your consultation, depending on your conditions and symptoms, Dr Clement will discuss the appropriate surgical and non-surgical options for you.
Breast Cancer
Breast cancer is the most common cancer affecting women. Breast cancer is where cells in the breast tissue multiply and grow abnormally. This abnormal growth of cells forms a tumour. This tumour can then invade and spread into the surrounding normal breast tissue and may also spread to the lymph glands or other parts of the body.
The risk of developing breast cancer increases with age. In Australia, 1 in 7 women and 1 in 670 men has the risk of developing breast cancer by the age of 85. In 2021, it is estimated that 20,825 Australians will be newly diagnosed with breast cancer. Although the majority of breast cancers develop in women over the age of 50, around 5% of women under the age of 40 can develop breast cancer. Approximately 5-10% of these cases can be due to gene mutations passed down from parents (BRCA 1 & BRCA 2) (bcna.org.au & breastcancertrials.org.au)
What causes breast cancer?
Older age
Being a woman
Dense breast tissue
Early age of menstruation and late menopause
Being overweight or obese
Excessive alcohol consumption
Smoking
Use of hormonal contraceptive pill
Hormone replacement therapy
Family history of breast cancer and genetic mutations (BRCA 1 & 2)
Personal history of previous breast cancer or even benign breast conditions
Having dense breast
Radiation to chest or face before the age of 30
What are the types of breast cancer?
The two main types of breast cancer are non-invasive & invasive.
1. Non-invasive or in situ breast cancer include:
Ductal carcinoma in situ (DCIS).
Lobular carcinoma in situ (LCIS).
Ductal carcinoma in situ (DCIS):
This is the most common type of non-invasive breast cancer, where the cancer cells are still within the milk ducts and has not spread into the surrounding breast tissues. If left untreated, it can develop into an invasive cancer later in your life.
Lobular carcinoma in situ (LCIS):
In LCIS, abnormal cells are still within the milk lobules (milk-producing glands) and have not spread into the surrounding breast tissues. Although this is not a true cancer, it is a risk factor for developing an invasive breast cancer later in your life.
2. Invasive breast cancers:
Two common types of invasive breast cancer include:
Invasive Ductal Carcinoma
Invasive Lobular Carcinoma
Invasive ductal carcinoma is the most common type of breast cancer, where the cancer develops from within the milk ducts. In invasive lobular carcinoma the cancer develops from the milk lobules. These cancer cells then invade and spread into the surrounding breast tissues.
Symptoms of breast cancer.
What are the symptoms of breast cancer?
Breast cancer symptoms can vary widely. Often women may not have any symptoms, no lumps, bumps or pain. However, it can also present itself as a lump in the breast, skin dimpling or tethering, change in breast shape, skin changes-redness or scaly skin, and nipple discharge. Sometimes the lump can be too small to feel or cause any symptoms.
In a locally advanced cancer, you may be able to feel lumps in your axilla (armpit) with swollen lymph glands.
Breast cancer can also be picked up through the breast cancer screening program where an abnormality is identified on a screening mammogram and or ultrasound.
If you have any of the following symptoms you should see your GP and get referral to a specialist:
Breast pain
Swelling of part or all of the breast
Feel a breast lump
Skin changes - irritation, dimpling, tethering, redness, scaliness, thickening of the nipple, areola or breast skin
Nipple inversion
Nipple discharge other than lactation (breast milk)
Breast asymmetry
Lump in the armpits
Breast Cancer Network Australia (BCNA) and US Breastcancer.org also has extensive information regarding breast cancer.
Breast cancer treatment
Breast cancer treatment includes a combination of surgery, chemotherapy, radiotherapy, and hormone therapy. The best treatment will depend on the type of cancer, size, location and also what stage it has reached (i.e early, locally advanced, or metastatic). Dr Clement will discuss the best option for you thoroughly during your consultation.
Breast cancer surgery
Prior to planning for the surgery, you may need further scans and blood test to check if the cancer is early and located just in the breast or has progressed into the lymph glands or elsewhere in the body.
After those staging investigations, appropriate treatment options will be discussed, and surgery will be planned. Dr Clement will explain, guide and support you through every step of your breast cancer treatment.
Breast conserving surgery:
Dr Clement is a highly trained and experienced breast oncoplastic & reconstructive surgeon, who can remove the cancer at the same time conserve your breast by using advanced plastic surgical techniques and maintain optimal cosmetic outcome after the surgery. In some patients this is an excellent option as it avoids having a mastectomy (where the whole breast is removed).
In patients who are at risk of getting a depression or deformity after a wide local excision, Dr Clement will recommend different types of surgery using oncoplastic surgical techniques.
Advanced Oncoplastic Surgery:
Dr Clement is skilled in advanced oncoplastic surgical techniques, where he can remove the breast cancer and re-shape the breast by breast reduction or moving tissue from other areas of your body to fill the part of the breast that has been removed. This will also result in a more youthful and smaller breast.
Dr Clement performs the following Oncoplastic Surgeries:
Therapeutic mammoplasty using breast reduction techniques.
Mastopexy-using breast lift techniques.
Perforator flaps-Using your own tissue from other parts of your body to reconstruct the defect. Dr Clement specialises in advanced perforator flap surgery-AICAP, LICAP, TDAP.
Symmetrisation breast surgery:
Dr Clement can perform symmetrisation surgery on the unaffected breast to make both the breast look symmetrical. This may include a combination of breast reduction, breast lift, and or breast augmentation (enlargement).
Mastectomy:
Mastectomy is a procedure where all your breast tissue is removed.
There are different types of mastectomy:
Simple mastectomy: Removal of breast including the skin and nipple. Following this surgery women can choose to wear a breast prosthesis inside the bra or undergo breast reconstruction.
Skin sparing mastectomy: Removal of the breast tissue and the nipple but the skin envelop over the breast is left for optimal breast reconstruction.
Nipple sparing mastectomy: Removal of breast tissue leaving the skin and nipple with areola behind. This allows an immediate breast reconstruction to be performed and can achieve an excellent cosmetic outcome.
Risk reducing mastectomy/prophylactic mastectomy: If you have a high-risk family history or genetic mutations (BRCA 1 & 2), you may choose to have risk reducing surgery. This can include any of the previously mentioned mastectomy types with or without breast reconstruction.
During your consultation Dr Clement will discuss with you all the mastectomy and reconstructive options to suit your needs.
Axillary surgery:
Breast cancer can spread to the lymph glands in the axilla (armpit). This does not mean that the cancer has spread to the rest of the body, but it checks the lymph glands and helps to plan the correct treatment for you.
Sentinel lymph node biopsy - Dr Clement uses special techniques using nuclear medicine and a blue dye (Dual-mapping) to identify the sentinel lymph node (primary lymph gland or glands the breast tissue drains into) and remove the sentinel lymph glands for assessment.
Axillary node clearance/axillary lymph node dissection: In patients where the cancer has spread to the lymph nodes, Dr Clement can remove the lymph glands under the armpit which drains the breast tissue.
Chemotherapy:
Some patients may need chemotherapy, either before (neoadjuvant) or after (adjuvant) the surgery. This will depend on several factors such as the type, grade, size of cancer and also if the cancer has spread to the lymph glands. If chemotherapy is required, you will be referred to a medical oncologist.
Radiotherapy:
All patients who undergo breast conserving surgery for invasive breast cancer will be recommended radiotherapy to the breast and or to arm pit area. In some patient’s radiotherapy may be offered before surgery so an immediate flap-based reconstruction can be performed at the same time as the cancer surgery.
If you require radiotherapy, you will be referred to a radiation oncologist.
Hormone/Endocrine therapy:
After surgery, some patients may require adjuvant hormone therapy for an extended period. In selected patient’s, hormone therapy may be offered before surgery or even instead of surgery.
Multidisciplinary care
Dr Clement offers multidisciplinary care for all his patients. Individual patient’s diagnosis is discussed in a multidisciplinary team meeting (surgeons, medical oncologists, radiation oncologists, pathologist, radiologist, geneticist, and breast care nurse). This helps to recommend the best treatment option tailored for each patient.
Dr Clement and his breast care nurse will help and support you through this stressful time.
Benign Breast Conditions
Not all breast symptoms are cancerous. Most symptoms such as breast pain and lumpy breast can be common and may not be related to cancer. Dr Clement can investigate and manage all your benign breast conditions.
Breast pain:
Mastalgia or breast pain is a common symptom experienced by women in their childbearing years. Women can feel heaviness, fullness, increased lumpiness, discomfort or pain in their breasts. This can be sometimes related to the menstrual cycle. Usually modification of lifestyle factors and some medications can help to manage the pain.
Benign breast lumps - Fibroadenoma:
Fibroadenoma is a benign non-cancerous lump. It develops from the fibrous tissue in the breast. They are common in women of childbearing age. It usually feels firm, smooth, and the lump can move around when pressed on it. Although fibroadenoma are not cancerous, it can grow and cause discomfort, pain, and can affect the cosmetic appearance of the breast.
Benign breast cysts:
Breast cysts are fluid filled lumps in the breast tissue. It is common in women in the age group between 30-50. Cysts usually regress and cease with menopause. Cysts can appear as smooth lumps, soft to firm to feel and can be mobile. You can have one or more cysts in either one or both the breasts. Cysts can have no symptoms or can present with pain or discomfort.
Nipple discharge:
Fluid discharge from the nipple is common. Most nipple discharge is benign and not related to cancer; however, nipple discharge in women who are not pregnant, or breast feeding can be related to cancer. The colour of the discharge can vary from white, brown, green, or bloody. It may occur on one or both the nipples.
Surgery to treat nipple discharge include: Microdochectomy (single duct excision) and Total duct excision (all of the ducts under the nipple removed).
Gynaecomastia:
This conditions sometimes referred to as “man boobs” is a common condition in boys or men where their breast becomes larger than normal. It is common in teenage or older men and is caused by an imbalance in the hormones. This can cause pain, discomfort and affect the cosmetic appearance of the chest and the embarrassment can lead to lack of confidence and self-esteem. Some men may need male breast reduction to manage this condition.