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Breast Care

  • Know your breasts
  • Know your risks
    • Modifiable risks factors
    • Genetic counselling and testing
    • Breast cancer risks assessment tools
  • Attend regular breast screening

Introduction

Breast cancer is the world's most prevalent (common) cancer. According to the world health organisation (WHO), in the year of 2020, there were 2.3 million people diagnosed with breast cancers. Amongst all the breast cancers diagnosed, 1% are male breast cancers. In the year of 2020, WHO reported 685,00 deaths from breast cancers globally. However, in the same year, we had more survivors than people dying from breast cancers, 7.8 million survivors, survived after 5 years of diagnosis and treatment.

The majority of the time, that is 90-95% of breast cancers are due to multiple risks factors: modifiable risks factors and non-modifiable risks factors. Only 5-10% of breast cancers are due to genetic mutations. The two most commonly known genes mutation associated with high risks of developing breast cancers are BRCA1 and BRCA2 genes.

In Malaysia, a woman's lifetime risks of developing breast cancer is 1 in 20. But it is more common in the Western World, for instance in the United Kingdom, a woman's lifetime risks of developing breast cancer is 1 in 8.

In 1985, the breast cancer awareness month was established, its aim was to promote mammogram as the best population-based breast cancer screening tool to detect cancer early. Research showed that early diagnosis of breast cancers with early treatment can result in good, excellent outcomes or even curative. In 1992, the “Pink October month” was established, since then there has been a growing global movement to further raised the importance of breast cancer awareness via various events.

Breast cancer awareness encompasses three main components:

Know your breasts
It is important for women to perform regular, once a month self-breasts examination (SBE) with the right techniques using the flat and pulps of fingers but not the fingers' tips. A doctor or a breast surgeon can show you how to examine your own breasts. Perform SBE in front of a mirror, then in the shower whilst it is soapy and slippery or after shower when lying flat whilst moisturising.

For premenopausal women, it is advised to perform a SBE when period finishes.

For post-menopausal women or women with no period due to the use of contraception, you can perform a SBE on the 1st of every month. Men should do this too as 1% of all breast cancers can happen in men.

Generally, any breast lumps smaller than 1.5-2cm in size is very difficult to feel unless it is very close to the skin. If noticed any lumps or new breast changes then you must make an appointment to see either a family doctor (general practitioner) and/or a breast surgeon.

Know your risks
  • Modifiable risks factors
    Breast cancer is the commonest cancer in the world. Most of the time, that is 90-95%, it is due to multiple risks factors (modifiable or non-modifiable risks factors). Alcohol consumption, smoking, obesity (unhealthy dietary and sedentary lifestyle) are all known modifiable risk factors for breast cancer.

    Some women may worry about the risks of developing breast cancer from taking Hormonal Replacement Therapy (HRT) or Menopausal Hormonal Therapy (MHT). However, this is more complex and it requires specialists' discussion about the balance of the individual's benefits and risks from taking HRT or MHT. More often than not, the benefits of HRT or MHT outweigh the risks of its use.

    Non-modifiable risks factors includes being women and aging. The theory about longer exposure to oestrogen like early menarche (early period) and late menopause has been suggested to be one of the risks factors for breast cancer. Also, we cannot change our family history and inherited genetic mutation associated with breast cancers. Whilst some says that late pregnancy and not breast feeding are modifiable risks factors, I would say that we need to be sensible about age of pregnancy and also whether women are able to breast feed, as some are unable to breast feed due to multiple reasons.
  • Genetic counselling and testing
    You may wish to understand your risks (normal, moderate or high) of developing breast cancer by seeing a breast surgeon and/or a genetic counsellor before deciding how often you should be having breast screening. Genetic counselling and testing are usually recommended for other people who are at higher risk for inherited gene mutations, including:
    • Family history of a BRCA (or other relevant) genes mutations
    • Family history of male breast cancer, ovarian cancer, pancreatic cancer, or high-grade or metastatic prostate cancer
    • Family history of breast cancer at a younger age (especially younger than 40 years old)
    • Family history of 1st degree (mother, sister, daughter) with breast cancers.
    It is important that anyone considering genetic counselling and testing understand the implications of test results, its pros and its cons. Including individualised screening programme to detect cancer as early as possible as well as preventative measures to reduce the risks of developing breast cancer. Angelina Jolie, was one of the most well-known persons, whom shared her diagnosis in BRCA 1 gene mutation and how she undergone risks reducing mastectomy in 2013, at the age of 35.
  • Breast cancer assessment tools
    In more recent time, there has been an increasing awareness of using breast cancer assessment tools to determines the risks of developing breast cancer. But these assessment tools are mainly developed from the Western “White” population and may not be as accurate as it can be for the Asians or “Non-White” population. In 2024, Olivia Munn, was nominated as one of the top TIMEs 100 most influential people in health for sharing her breast cancer diagnosis at the age of 43, after using one of these assessment tools https://ibis-risk-calculator.magview.com/, she found to be at high risks of developing breasts cancer. A MRI breasts investigations found bilateral breast cancers, despite a negative genetic testing and a normal mammogram.

    In Malaysia, the Cancer Research Malaysia has built one of the largest genetic database of Asian breast cancers and have developed ARiCa - a personalized risk prediction tool used to calculate the likelihood of a breast cancer woman carrying a BRCA genetic change.

    The following links provides more information on Cancer Research Malaysia and ARiCa:
    https://www.cancerresearch.my/
    https://www.arica.cancerresearch.my/

Attend regular breasts screening
Breast screening uses an X-ray test called a mammogram to check the breast for signs of cancer. It can spot cancers that are too small to see or feel. 3D Mammogram (Tomosynthesis) - This has shown to enhance the detection and characterisation of breast abnormalities, especially in younger women, aged between 40 to 50 with denser breasts (breasts with less fat) to avoid unnecessary biopsies.

How often a woman attend for breast screening mammogram would depend on the woman's lifetime risks for developing breast cancer: normal, moderate or high risks for developing breast cancers.

Some developed countries like the UK, the USA, Canada and Australia have national breast screening programmes. There are some differences in the recommended screening age, methods and intervals among the screening programmes of the different countries.

National breast screening programmes in the some “Western” developed countries
UK Once every 3 years from 50 years of age (47/50-70/73)
US Once every 2 years from 40 years of age (40-74)
Canada Once every 2-3 years from 40 years of age (40-74)
Australia Once every 2 years from 50 years of age (50-74)
Whilst there is no breast screening programme in Malaysia. I would recommend women age 40 years onwards to attend breast screening mammogram +/- ultrasound scan breast once every 2-3 years. Unless moderate or high risks then patient would be advised to attend breast screening yearly. In addition to seeing breast specialists to discuss early detection with yearly screening other strategies to reduce risks of breast cancer.
  • Normal risks
    A normal woman's life time risks of developing breast cancer is 1 in 20 in Malaysia and 1 in 8 in United Kingdom (UK). It is recommended that women age 40 years and above to start breast screening with mammogram once every 2 to 3 years. You can ask your breast doctor/surgeon or breast radiologist the difference between 2D or 3D mammogram. A 3D mammogram offers advantages in detecting breast cancer in people with dense breast tissue because the 3D image allows doctors to see beyond areas of density. Breast tissue is composed of glands, ducts and supportive tissue (dense breast tissue) and fatty tissue.

    Some women younger than 40 years of age, usually between 25-39 may choose to have regular yearly or biannually breasts ultrasound scan as part of self-initiated breast health check.

    UK National Health Screening Programme
    In some countries like the UK, the national health service (NHS) breast screening programme for the normal population starts from 50 years old once every 3 years. According to the UK data, for every 100-breast screening mammogram performed they will detect 4 that needs further tests and one will be a breast cancer. For every 200 breast screening mammogram performed, they can save one life. https://www.gov.uk/government/publications/breast-screening-helping-women-decide/nhs-breast-screening-helping-you-decide

    US Preventative Services Task Force Breast Screening
    The Task Force recommends that all women get screened for breast cancer every other year, starting at age 40 and continuing through age 74, to reduce their risk of dying from this disease.
    https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/breast-cancer-screening

    Canadian Task Force on Preventive Health Care - Breast Screening
    Women aged 40 to 74 should be provided information about the benefits and harms of screening to make a screening decision that aligns with their values and preferences. If someone in this age range is aware of this information and wants to be screened, they should be offered mammography screening every 2 to 3 years.
    https://canadiantaskforce.ca/wp-content/uploads/2024/09/Breast-Cancer-Update-Draft-Recommendations_v4.pdf

    Australia Breast Screening Programme
    Australian Cancer Council recommends women aged 50-74 to attend breast screening mammogram once every 2 years.
    https://www.cancer.org.au/cancer-information/causes-and-prevention/early-detection-and-screening/breast-cancer-screening
  • Moderate risks
    Patient with moderate risks of developing breast cancer would be advised to have breast screening with mammogram +/- ultrasound breasts once a year from age 40 to 49 followed by once every 2-3 years from 50 years old onwards. You may also wish to discuss ways to reduce your risk of cancer developing, like lifestyle changes and the pros and cons of taking antihormone tablet for 5 years.
    https://www.swbh.nhs.uk/wp-content/uploads/2014/07/moderatepre1.pdf
  • High risks
    Patient with high risks of developing breast cancer would be advised to start breast screening earlier. Typically, with MRI breasts from 25-40 years old, which has to be timed with the menstrual cycle, day 7 to day 14 of menstrual cycle. The first day of your period is day 1 of your cycle.

    Followed by yearly mammogram from 40 to 70 years old. You will be counselled about lifestyle changes, risks and benefits of chemoprevention (that is taking antihormone tablets for 5 years to reduce your risks of developing breast cancer if you have found to have BRCA2 gene mutation). You may also wish to discuss the pros and cons of risks reducing surgeries like prophylactic mastectomies with or without reconstruction with your breast surgeon.

  1. CLINICAL ASSESSMENT BY SURGEON
    1. History taking
    2. Bedside examination with or without bed side ultrasound scan breasts.
  2. RADIOLOGICAL BREAST INVESTIGATION(S)
    < 40 years old ≥ 40 years old
    Ultrasound Scan (USS) breasts (may or may not need MRI breasts) Mammogram (likely need USS breasts and may or may not need MRI breasts)
  3. BIOPSY SPECIMEN ASSESSMENT BY PATHOLOGIST
    1. Biopsy of breasts lesion for confirmation of diagnosis.
Most breast lumps would need triple breast assessments. That means, a doctor specialising in breast will perform an assessment by taking a history from the person presenting with any signs and/or symptoms of breast cancer. This is followed by breast examinations with or without a bedside ultrasound scan (USS) breast as an extension of the doctor's physical examinations.

Often, the doctor will organise further breasts investigations, like mammogram for over 40 years old with another formal repeat USS breasts performed by the radiologist.

Both clinical assessment and radiological investigations can allow the doctor to come up with a clinical and radiological diagnosis.

Most of the time, biopsy of breast and/or axillary (armpit) lumps will be needed to complete the triple breast assessment to get a definitive diagnosis. In some rare occasions, further biopsies may be necessarily. However, not all breasts' lumps need to be biopsy but often will need monitoring.

As part of the triple breast assessment or after the triple breast assessment for a breast lump that had been biopsied, an excision biopsy is required or necessary to make sure that we can exclude malignancy confidently. Sometimes, excision biopsy is requested by the patient.
  • Wide local excision
  • Microdochectomy
  • Hadfield procedure - Total Duct Excision
  • Lymph node excision biopsy
  • Benign breast or axilla procedures
    • Excision biopsy

The following are common benign (not cancer) breast conditions and links to information and resources related to those conditions.
  1. Breast pain
    https://breastcancernow.org/sites/default/files/publications/pdf/bcc71_-_breast_pain_-_web_pdf.pdf
  2. Fibrocystic breast changes
    Fibrocystic breasts are composed of tissue that feels lumpy or rope like in texture. Doctors call this nodular or glandular breast tissue.

    It's not at all uncommon to have fibrocystic breasts or experience fibrocystic breast changes. In fact, medical professionals have stopped using the term "fibrocystic breast disease" and now simply refer to "fibrocystic breasts" or "fibrocystic breast changes" because having fibrocystic breasts isn't a disease. Breast changes that fluctuate with the menstrual cycle and have a rope like texture are considered normal.

    Fibrocystic breast changes don't always cause symptoms. Some people experience breast pain, tenderness and lumpiness — especially in the upper, outer area of the breasts. Breast symptoms tend to be most bothersome just before menstruation and get better afterward. Simple self-care measures can usually relieve discomfort associated with fibrocystic breasts.
  3. Breast cysts
    https://breastcancernow.org/sites/default/files/publications/pdf/bcc73_-_breast_cysts_-_web_pdf_0.pdf
  4. Fibroadenoma
    https://breastcancernow.org/sites/default/files/publications/pdf/bcc72_-_fibroadenoma_-_web_pdf.pdf
  5. Intraductal papilloma
    https://breastcancernow.org/sites/default/files/publications/pdf/intraductal_papilloma_final_-_web_version.pdf
  6. Fat necrosis
    https://breastcancernow.org/sites/default/files/publications/pdf/bcn_dl_fat_necrosis_2022_web.pdf
  7. Chronic granulomatous mastitis (CGM) or Idiopathic granulomatous mastitis (IGM)
    https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10834090/pdf/TBJ2024-6693720.pdf and/or https://breastcancernow.org/about-breast-cancer/breast-lumps-and-benign-not-cancer-breast-conditions/granulomatous-mastitis/
  8. Gynaecomastia
    https://breastcancernow.org/sites/default/files/publications/pdf/bcc155_-_gynaecomastia_-_web_pdf.pdf or https://www.nottsapc.nhs.uk/media/f31dx2id/gynaecomastia-guideline.pdf
  9. Granulomas
    https://www.healthdirect.gov.au/granulomas
  10. Duct Ectasia
    https://breastcancernow.org/sites/default/files/publications/pdf/bcn_duc_ectasia_2023_web.pdf
Other benign condition
  1. Sebaceous cysts
    https://patient.info/skin-conditions/epidermoid-and-pilar-cysts-sebaceous-cysts-leaflet
  2. Lipoma
    https://patient.info/skin-conditions/lipoma-leaflet
  3. Eczema of the nipple areolar
    https://dermnetnz.org/topics/nipple-eczema

Most common breast cancer condition
  1. Non-invasive
  2. Invasive
    • Subtypes
Below are all relevant information, almost all are produced in the UK, whilst not all applicable to patients outside the UK, mostly are still relevant.

Paget's disease
Paget's disease of the nipple, also known as Paget's disease of the breast, is a rare condition associated with breast cancer. It causes eczema-like changes to the skin of the nipple and the area of darker skin surrounding the nipple (areola). It's usually a sign of breast cancer in the tissue behind the nipple.
https://breastcancernow.org/sites/default/files/files/pagets_disease_of_the_breast.pdf

Non-invasive breast cancer
About 1 in 5 women diagnosed with breast cancer through screening will have non-invasive cancer. This means there are cancer cells in the breast, but they are only found inside the milk ducts (tubes) and have not spread any further. This is also called ductal carcinoma in situ (DCIS). In some women, the cancer cells stay inside the ducts. But in others they will grow into (invade) the surrounding breast in the future. Doctors can't tell whether non-invasive breast cancers will grow into the surrounding breast or not. DCIS is also known as pre-invasive breast cancer. It can be classified as low risks DCIS or high risks DCIS.

Low risks DCIS are:
Low grade DCIS;
Intermediate grade DCIS.

High risks DCIS is also called
High grade DCIS.
https://breastcancernow.org/sites/default/files/publications/pdf/bcn_dcis_web.pdf

Invasive breast cancer
About 4 in 5 women diagnosed with breast cancer through screening will have invasive cancer. This is cancer that has grown out of the ducts and into the surrounding breast. Invasive breast cancer means that the cancer cells have grown through the lining of the ducts into the surrounding breast tissue. Most invasive breast cancers have no special features and are classed as No Special Type (NST) or not otherwise specified (NOS). Between 70 and 80 out of 100 (between 70 and 80%) breast cancers are this type. Special type means that when the doctor looks at the cancer cells under a microscope the cells have particular features. Breast cancers that are classed as special types include some rare types of breast cancer.
https://breastcancernow.org/sites/default/files/publications/pdf/bcc210_invasive_breast_cancer_2021_web.pdf

Invasive breast cancer subtypes
Breast cancer subtypes is determined by looking at 3 receptors on cancer cells:
  • oEstrogen receptor (ER)
  • Progesterone receptor (PgR)
  • Human epidermal receptor growth factor 2 (HER2) receptor
https://www.breastcancer.org/types/molecular-subtypes

Multidisciplinary and multiprofessional team in breast cancer management

Breast cancer treatment involves local and systemic treatment provided by a multidisciplinary and multiprofessional team. Treatment is tailored according to the molecular subtypes of breast cancer, and also weighing up the risks and benefits as well as the side effects of each treatment modalities.

Ultimately, your breast cancer multidisciplinary team is working together to treat, stage and to cure you by reducing the risks of cancer coming back in the future either in, near and far from your operated breast, as cancer can come back elsewhere in your body like, lung, liver, bone or brain.

Local treatments are:
  • Surgery
  • Radiotherapy
    • Intra-operative radiotherapy (IORT)
    • External beam radiotherapy (EBRT)
Systemic treatments are:
  • Anti hormone treatment
  • Chemotherapy
  • Targeted treatment
https://breastcancernow.org/about-breast-cancer/treatment/the-multidisciplinary-team-mdt/

DAY-CASE, CLINIC BASED BREAST PROCEDURES

Breast radiologists and/or surgeons can perform the following procedures as a day-case under local anaesthetics:
  • Biopsy of breast lesions or lumps
  • Aspiration of breast fluid like cysts, abscess and seromas
  • Incision and drainage of abscess

Breast Benign Condition Surgery - Breast lump excisions biopsy (for example fibroadenoma, lipoma, sebaceous cyst and etc)

Breast Cancer Surgery Procedures
Breast cancer surgery remains the main local treatment for breast cancer. Depending on the size and subtypes of breast cancer, whilst surgery is the first breast cancer treatment, in some cases surgery is only recommended after systemic treatment with either anti-hormone treatment or neoadjuvant chemotherapy with or without targeted treatment.

There are 3 main types of breast surgeries:
  1. Breast conserving surgery (BCS)
    Removal of breast cancer in the form of lumpectomy with a rim of healthy breast tissue "safety" margins, known as wide local excision with or without using oncoplastic breast surgical techniques. There is 10-20% risks (1 in 4 or 1 in 5 chance) that you may need more surgery to clear the "safety" margins.
  2. Mastectomy (Mx)
    Mastectomy is when 90-95% of breast tissue is removed. It depends whether you wish to have or whether you can have reconstructions, your surgeon(s) will advise you whether your breast skin and nipple can be kept; as well as the types of reconstructions option(s) suitable for you.
  3. Axillary surgery (BCS)
    Axillary surgery is usually performed at the same time of breast cancer surgery. And there are 3 types of axillary surgeries:
    1. Sentinel lymph node biopsy (SLNB)
      Sentinel lymph node biopsy means removing the first axilla lymph nodes(s) drained by the breast, it can be one or more lymph nodes.

      It is performed at the same time of the breast surgery when an invasive breast cancer is diagnosed, and when the same side axilla felt and looked normal at diagnosis, that is clinically and radiologically normal axilla. In non-invasive or DCIS, SLNB is also performed when patient has a mastectomy.

      On the night before or on the day of your surgery, you will be arranged to attend the nuclear medicine department for a radioactive dye injection near your nipple to help the surgeon to find and remove the SLNB. During the surgery, the surgeon may also use a blue dye to help with removing the SLNB.

      If the surgeon is unable to find the SLNB then your surgeon will proceed with axillary node sampling (ANS), that is remove any palpable 4 lymph nodes in the axilla.

      The SLNB removed can then sent for frozen section, where it is analysed by the pathologist during surgery, if there is any cancer cells in the SLNB, then your surgeon will proceed with axillary node clearance.
    2. Axillary node clearance (ANC)
      Level II axillary node clearance means that removing about 2/3rd of your axillary lymph nodes.
    3. Targeted axillary dissection (TAD)
      TAD is usually performed after neoadjuvant chemotherapy (chemotherapy given before surgery). This is when the proven abnormal lymph node from needle core biopsy was clip, after chemotherapy the surgeon will have to remove the clipped node and SLNB. It should be minimum of 4 nodes removed. This is a recent modern technique and not all hospitals provide this surgery.
Breast cancer surgical treatment
  • Breast conserving surgery (BCS)
    • Wide local excision (lumpectomy)
      • Wire guided
      • USS skin marked
      • Non-image guided
    • Oncoplastic level 1
      Breast Oncoplastic level one surgery - Removing the breast cancer and filling the gap with surrounding breast tissue to reduce the risk of defects, using a modified Benelli round block technique.
      • wide local excision
      • Benelli
    • Oncoplastic level 2
      Therapeutic mammoplasty is a procedure that removes breast cancer, reduces breast size, and uplifts the breast at the same time. There are various types of therapeutic mammoplasty, depending on the patient's breast size and shape. Some examples include:
      • Reduction mammoplasty
      • Lejour or Vertical Mammoplasty
      • Wise Pattern Mammoplasty
      • Lateral Mammoplasty
      • J-Mammoplasty
      • Racquet Mammoplasty
      • Grisotti Technique
      • Batwing Mammoplasty
      • Mastopexy
    • Oncoplastic level 3 (partial breast reconstruction)
      Some patients can avoid mastectomy even if the cancer is large, thanks to oncoplastic and reconstructive breast surgery. The breast size can be restored using chest wall perforator flaps, which involve wide local excision and partial breast reconstruction with chest wall perforator flap using chest fat with its blood supply near the patient's breast. There are several types of chest wall perforator flaps, including:
      • Anterior Intercostal Artery Perforator (AICAP) Flap
      • Middle Intercostal Artery Perforator (MICAP) Flap
      • Lateral Intercostal Artery Perforator (LICAP) Flap
  • Mastectomy (Mx)
    Mastectomy with or without full breast reconstruction. Removal of breast is also known as mastectomy. There are many types of mastectomies:
    • Simple mastectomy
      Where breast is removed along with nipple and areolar complex.
    • Nipple sacrificing skin sparing mastectomy
      This procedure can be performed when a patient wishes to have immediate breast reconstruction and has small or medium-sized breasts. The nipple areolar complex is removed.
    • Nipple sparing skin sparing mastectomy
      This procedure can be performed when a patient wishes to have immediate breast reconstruction and has small or medium-sized breasts. The nipple can safely be preserved, provided no cancer is found behind it.
    • Nipple sparing skin reducing mastectomy
      This procedure can be performed when a patient wishes to have immediate breast reconstruction and has large, drooping (ptotic) breasts. The nipple can safely be preserved, provided no cancer is found behind it.
  • Breast reconstruction
    • Immediate
      • Breast Implant reconstructions
        • Pre-pectoral
        • Subpectoral
      • Autologous breast reconstructions
        • LD
        • TRAM
        • DIEP
      • Combined
    • Delayed
      • Breast implant reconstructions
        • Staged expander
      • Autologous
      • Combined
  • Axillary surgery
    • Axillary node biopsy
    • Sentinel lymph node biopsy (SLNB)
    • Sentinel lymph node sampling (SLNS)
    • Targeted axillary node dissection (TAD)
    • Axillary node clearance
    • Axillary accessory breast tissue
  • Nipple Related Surgery
    • Microdochectomy
    • Total duct excision or Hadfield surgery
    • Nipple reconstruction
    • Nipple reduction
    • inverted nipple correction
  • Breast Risks Reducing Surgery
    Patients at high risk of developing breast cancer due to genetic mutations or family history, but who do not have a current breast cancer diagnosis, may consider preventative surgery, such as risk-reducing mastectomies with or without reconstruction. Risk-reducing mastectomies can lower the risk of breast cancer by 90-95%. This decision should be made with careful consideration and involve comprehensive consultations to discuss the risks and benefits of preventative surgeries
Your operation and recovery
https://breastcancernow.org/sites/default/files/publications/pdf/bcc151_your_operation_and_recovery_2022_web.pdf

Breast Cosmetic or Revisional Surgery
Patients with a history of breast cancer-related surgeries, breast reconstruction surgeries, or other cosmetic breast procedures who are concerned about the appearance of their breasts may benefit from an assessment by an oncoplastic and reconstructive breast surgeon or a plastic surgeon. They can propose further surgical interventions to improve the appearance of the breasts. Often, breast investigations may be required before any revisional or additional cosmetic breast surgeries. These interventions may include:
  • Removal and/or replacement of breast implants
  • Excision of silicone granulomas or mastectomy with or without partial or full breast reconstruction
  • Breast reduction and uplift surgery (mammoplasty)
  • Breast uplift surgery (mastopexy)
  • Breast enlargement or augmentation with breast implants
  • Breast enlargement or correction of defects with lipomodelling
  • Surgery to male breast tissue called gynaecomastia
  • Scar revisions
Post breast cancer axilla (armpit) surgery exercises
https://breastcancernow.org/sites/default/files/publications/pdf/bcc6_-_excercises_after_breast_cancer_surgery_-_web_pdf.pdf

Bone health
https://be.macmillan.org.uk/Downloads/CancerInformation/LivingWithAndAfterCancer/MAC12169Bone-healthE03lowrespdf20170614ALM.pdf

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