2 June 2007: Breast cancer surgery - choice of patient

In 2004, there were 2,200 new cases of breast cancer in Hong Kong.

Although the rate of breast cancer occurrence within the "Standard Age" range is not as high as those of U.K. and U.S.A, it is still high when compared with Mainland China and Japan. According to Dr. Chan Chi Mui, Mammary Specialist of Kwong Wah Hospital : "Westernization of people's lifestyle, the aging population, and increased public awareness on breast cancer resulting from the advancement on breast cancer research had led to the trend in the growth of breast cancer occurrence in Hong Kong in the past 10 years. Breast cancer occurs mostly between the ages of 40-55."

Fortunately, the mortality rate of breast cancer is relatively low when compared with other types of cancer. Dr. Chan said : "The mortality rate for breast cancer still lags behind the No.1 killer, lung cancer. There were only 454 reported cases of deaths in 2004 as a result of breast cancers."

Self Photos / Files - 01s     Self Photos / Files - 02s


Mastectomy and Reconstruction

In the 50's and 60's, breast cancer surgery usually involved mastectomy. As a result, some patients feel handicapped and may experience some inconveniences in their daily lives. Nowadays, patients can wear prosthesis and their normal daily activities need not be affected. Alternatively, patients can choose "Breast Reconstructive Surgery".

There are two types of "Breast Reconstruction". One is the use of implants in the form of silicone bags filled with saline. The surgery is relatively simple but the downside is that the implants may change shape or leak. Another is the use of skin grafting which involves the removal of skin from the abdominal area. Rejection will rarely occur but there will be a scar in the abdominal area.


According to Dr. Chan, lumpectomy has certain limitations and is not suitable for patients with the following conditions :

  • Multiple tumors
  • Large tumors
  • Tumor located near or underneath the nipple
  • Patients who cannot receive radiation treatment due to other pre-existing conditions

Whereas, patients with the following conditions are good candidates for lumpectomy :

  • Single tumor
  • Tumor not more than 3 mm
  • Tumor located at periphery of breast

Sentinel Node Biopsy

Sentinel Node Biopsy can accurately detect the occurrence of 95% of the cancer without removing all the lymph nodes. With sentinel node biopsy, only a few lymph nodes are removed for examination to see if they are cancerous. The success rate is 90%. If the nodes contain cancerous cells, further operation will need to be performed.

Comparison of the two types of surgery

If a patient was given the choice of either mastectomy or lumpectomy, the doctor will have to explain to the patient the pros and cons of each. For lumpectomy, patients need to consider recurrence of the cancer, the side-effects of radiotherapy, the size of the wound, the shape of the breast, etc. Whereas for mastectomy, the disadvantages include the wearing of prosthesis, bigger scars and body shape handicap. Doctors will often advise patients who undergo mastectomy to consider breast reconstruction surgery but at the expense of longer surgical hours, higher risk and prolonged recovery period. The decision largely depends on individual needs.