Breast cancer ranks the first in female cancer incidence worldwide. In 2018, there were over 2 million women diagnosed to have breast cancer, and 627 thousand women died of the disease. In Hong Kong, there were 4373 women diagnosed to have breast cancer in 2017, summing up to 27% of all female cancers.  Breast cancer has been at the top of the list of female cancer incidence since 1994. The median age of developing breast cancer is 57, and the lifetime risk before age 75 is 1:15. Yet, due to the nature of tumour and the advancement in medicine, the mortality is not as high as in lung cancer and colorectal cancer. Nevertheless, we should never underestimate the physical impact and socioeconomic burden of this disease.

Apart from malignancy, there are also various benign breast conditions. Some of them carry an increased risk of developing breast cancer, while others do not. An accurate diagnosis is important to guide further management of the condition, whether to observe, to biopsy or to remove it. No matter it is benign or malignant, it is always recommended to consult a breast surgeon to tailor-make an individualized treatment plan for you.

Malignant conditions: Invasive carcinoma, ductal carcinoma-in-situ, malignant phyllodes tumour

Benign conditions: mastalgia, breast cyst, fibrocystic change, fibroadenoma, ductal ectasia, papilloma, atypical ductal hyperplasia, benign phyllodes tumour, breast abscess, breast calcification on mammogram

• Skin dimple
• Lump in breast
• Pain in breast
• Bleeding from nipple
• “Orange peel” appearance
• Lump in axilla

Triple assessment is essential in the diagnosis of breast cancer:

1. Clinical assessment
2. Radiological assessment: mammogram, ultrasound, magnetic resonance imaging (MRI)
3. Histological/ cytological assessment

If there is suspicion of distant metastasis, computed tomography (CT) scan, bone scan or positron emission tomography (PET) scan may be required.

Surgery is the mainstay of treatment for breast cancer. Operation does not only aim at removing the tumour, but also preserving a satisfactory body image after operation.

Common operative procedures include simple mastectomy, breast-conserving surgery and mastectomy with reconstruction. Axillary procedures like sentinel lymph node biopsy and axillary dissection are often required.

Apart from tumour removal, adjuvant therapy is sometimes required to reduce the risk of recurrence and improve survival. Adjuvant therapy includes chemotherapy, radiotherapy, hormonal therapy and targeted therapy. Each modality has different treatment aim, and not every patient needs them.

• Clinical breast examination
• Ultrasound of breast
• Mammogram
• MRI of breast
• Ultrasound-guided core biopsy / fine needle aspiration cytology
• Ultrasound-guided marker insertion
• Ultrasound-guided aspiration of breast abscess/ incision and drainage
• Excision of breast lump
• Microdochectomy
• Breast cancer operation (simple mastectomy, breast-conserving surgery, mastectomy with immediate reconstruction, sentinel lymph node biopsy, axillary dissection)
• Post-operative scar management (topical ointment, injection for keloid)

• Ultrasound-guided core needle biopsy of impalpable breast lesions
• Excision of impalpable breast lesion with on table usg / magseed/ radioisotope guidance
• Endoscopic assisted nipple sparing mastectomy

Treatment does not stop after operation and adjuvant therapy. We also offer holistic care to patients, including post-operative wound management, physiotherapy, psychological support and dietetic advice. Our aim is to cure the disease and allow patients to return to normal activities as soon as possible.

Virtus General Surgery specialists

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