Breast cancer treatment: the importance of thorough surgical and post-operative care to prevent residual cancer

Posted: 31/03/2025

Breast cancer is the most common cancer in the UK, accounting for about 15% of all new cancer cases. Each year, there are approximately 56,000 new cases of breast cancer in women, which translates to over 150 cases diagnosed every day. While breast cancer primarily affects women, it can also occur in men with around 390 new cases reported annually.

Mastectomy, the surgical removal of one or both breasts, is a common treatment for breast cancer. Women and men may opt for this procedure for various reasons, including the size and location of the tumour, genetic predispositions or personal preferences. For instance, large or widespread tumours that cannot be effectively treated with a lumpectomy - which only removes part of the breast - often necessitate a mastectomy. Additionally, high-risk factors such as harmful variants in the BRCA1 or BRCA2 genes may prompt a choice to undergo mastectomy as a preventative measure.

This surgery aims to eliminate cancerous tissue and reduce the risk of recurrence, providing peace of mind and a sense of control. However, despite the thoroughness of the surgery, there is a risk that cancerous tissue may be left behind which could to residual cancer. This can occur if the surgery does not remove all the breast tissue or if microscopic cancer cells remain undetected. Residual cancer can manifest as a local recurrence, where the cancer reappears in the same area as the original tumour or a regional recurrence that affects nearby lymph nodes.

The presence of residual cancer underscores the importance of meticulous surgical techniques and comprehensive post-operative care to ensure that all cancerous cells are eradicated. The risk of residual cancer is influenced by several factors, including the initial size and aggressiveness of the tumour, the extent of the surgery, and the patient's overall health.

Surgeons strive to achieve clear margins - meaning that no cancer cells are found at the edges of the removed tissue. However, achieving clear margins can be challenging, especially in cases where the cancer is diffuse or located near critical structures. In such scenarios, additional treatments such as radiation therapy, chemotherapy or hormone therapy may be recommended to target any remaining cancer cells and reduce the risk of recurrence

For patients undergoing mastectomy, the possibility of residual cancer can be a source of anxiety and concern. Regular follow-up exams and monitoring are crucial to detect any signs of recurrence early. Symptoms of local recurrence may include new lumps, changes in skin texture or nipple discharge, while regional recurrence may present as swelling in the lymph nodes. Prompt reporting of any unusual symptoms to healthcare providers can facilitate early intervention and improve outcomes. Ultimately, while mastectomy is a powerful tool in the fight against breast cancer, it is not without its challenges.

We represented a woman who underwent a mastectomy to remove cancerous lesions from one breast. She had mastectomy surgery performed privately and underwent breast reconstruction. However, she was hugely distressed to subsequently discover breast lumps developing in her reconstructed breast and understandably feared the worst. She underwent various investigations, including biopsies, MRI scans, ultrasound scans and mammograms to determine the nature of these nodules. After being diagnosed with residual breast cancer, she underwent two further major surgeries and a third procedure. She was also put on endocrine therapy with Tamoxifen and required annual breast surveillance which added to her ongoing stress and worries about her health.

Our client had been pleased with her breast reconstruction following the mastectomy but the additional surgeries required its removal. She was left with extra scarring from the further procedures, serving as a constant reminder of her ordeal. To improve the symmetry of her breasts, she also underwent lipofilling. 
We investigated the standard of our client’s pre-operative advice, the standard of the mastectomy itself and how clear margins had falsely been reported when residual tissue had been left behind. A significant discrepancy between the volume of cancerous tissue known to be in the breast and that which was removed at mastectomy should have flagged the possibility of residual cancer.

However, due to poor communication between the private surgeon and private radiologist, this was not considered. Further opportunities at two separate multi-disciplinary meetings (MDTs) were not taken to consider and act upon the discrepancy.

A claim was brought and litigated against a denial of liability but was settled successfully at a joint settlement meeting. Our client began to feel vindicated that her claim had been met and that she had achieved the justice and recognition she was looking for. This case highlights the importance of thorough surgical and post-operative care to prevent residual cancer and the emotional toll it can take on patients.

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