Breast surgery and Cancer
Updated: Oct 25, 2022
An interview with Mr Vahan Kaplan, Consultant Breast Surgeon
Photo by Anna Shvets at Pexels
Q#1 - Please tell us about your professional background and career
I qualified at Istanbul University and then did my compulsory military service as a medical officer. Following that I moved to England and completed my general surgical training before specialising into breast surgery. Currently I work at Charing Cross Hospital mainly teaching, attending MDTs and running one stop breast clinics. I’m almost 50 years in the NHS now.
Q#2 - Why did you choose this profession?
When I was in primary school my father had a life threatening gastric bleed, the surgeon who saved him was an inspiration. Later, I looked after my elderly neighbour by doing regular wound care who had very advanced bed sores, again this experience enforced me to go into medicine. I decided to specialise into breast surgery whilst I was working at Northwick Park Hospital with a consultant who had been involved in developing early use of chemotherapy for breast cancer treatment. I was encouraged and realized the challenges ahead.
Q#3 - How would you describe the role of breast surgery in treating and preventing cancer?
Breast surgery is still very important to control the local spread of the disease and improving the survival. While 50 years ago, radical surgery alone was seen as the answer, it's now used in conjunction with other treatments such as endocrine treatment, chemotherapy and Radiotherapy. With improvement of adjuvant treatments now we are able to perform more conservative surgical techniques which allow us to conserve more of the breast and avoid mastectomies.
Q#4 - Is breast surgery necessary for all breast cancer patients or it depends on the case?
It very much depends on the case, for example the age of the patient and other underlying medical conditions can influence the treatment options. I myself have had several patients that haven’t undergone surgery but have responded to endocrine treatment so well that the cancer was not visible on imaging after a few years. Sometimes cancer is very advanced and it may be inoperable. Additionally the patient's own wishes must be considered and some will be reluctant to undergo surgery. The best course of treatment will be decided at a multidisciplinary meeting by a range of experts and specialists, so it can be tailored to the patient.
Q#5 - Could you tell us a little bit about the types of breast surgery?
There are four main groups: preventive, curative, palliative and reconstructive methods. Preventative is where a patient with a genetic abnormality or other precancerous condition may choose to undergo mastectomy rather than risk developing cancer. Curative is where we can remove the cancer that have been detected early on a mammography or other screening, or even in more advanced cases where the cancer is in the lymph glands, but without distant spread. Palliative surgery is performed in order to improve the quality of life by alleviating some of the symptoms. Main breast cancer operations are Lumpectomies, Sentinel lymph node biopsies, Therapeutic mammoplasties, Mastectomies and Axillary clearance (removing large number of lymph glands).
Q#6 - Can there be any long-term side effects from breast surgery?
Yes there can be, although it does depend on the type of surgery that’s been performed and also the oncologic result of surgery. There can be both psychological and physical side effects. Common physical side effects would be pain, delayed wound healing, infection, scarring, seroma collection, muscle weakness, implant problems, discrepancies, recurrence of cancer, lymphedema and fat necrosis.
Q#7 - What is breast reconstruction?
It’s what it says; reconstructing new breasts, we remove the breast tissue and we replace either using patient's own tissue from somewhere else on their body, often from their back or abdomen, alternatively with artificial implants. Sometimes we combine two methods together. I think it’s very important to involve the plastic surgeons at an early stages in the complex cases to insure the best cosmetic outcome for the patient. Depending on a case, there can be Immediate or Delayed reconstructions. Both avenues have pros and cons.
Q#8 - Is breast reconstruction recommended to all breast cancer patients or it depends on the case?
Of course it depends on the case, the patient's expectation, occupation, health and age group can all play a role. For example reconstruction may not be appropriate if the patient is a heavy smoker or has underlying serious health issues.
Q#9 - After breast surgery or reconstruction, how often should patients see their surgeons for check-ups?
This is again dependent on the patient, whether or not they're high risk. If recurrence is expected within the following five years then the patient should be seen more often by their oncologist. If surgical results are satisfactory and there is ontologically good outcome then patient can be discharged from outpatients within a year, however if there are complications then they should be seen more frequently.
Q#9 - As an experienced breast surgeon, what would be your number one advice to people living with cancer and beyond?
One important message is not compare yourself with other patients, as I’ve emphasised earlier every case is different and the same type of cancer might behave differently within different people. So don’t compare yourself and if you have any doubts seek advice from your oncologist or surgeon.