Sentinel Node Biopsy & OSNA

I have a particular interest in this technique which is the gold standard staging axillary (armpit) staging method for breast cancer surgery. I introduced the operation to Buckinghamshire and have presented important sentinel node research internationally. I was approved as a 'trainer' in the technique by the Royal College of Surgeons of England. More recently, I introduced the intra-operative analysis of sentinel nodes using molecular techniques (OSNA).  This means that the surgeon knows whether the node is positive or negative during surgery.  I have presented work on OSNA in the UK, Europe and America.

For invasive breast cancer, most women are offered breast conservation surgery with sentinel node biopsy, providing they do not have clinically abnormal lymph glands. Instead of removing most of the armpit lymph glands, only one or two glands are normally removed. This means that the patient has far fewer potential side-effects from surgery and typically goes home the same day! It requires a special scan before the operation and an injection of blue dye during the operation.

Mastectomy

If a mastectomy is deemed necessary, breast reconstruction will be offered if it is appropriate. The patient will undergo removal of the breast and usually some lymph nodes under the armpit. Wound drains are sometimes required. A local anaesthetic block is given during the operation to reduce postoperative pain. Most ladies go home as a day case, thanks to the modern approaches used.

Breast Reconstruction

If possible, immediate breast reconstruction is offered. I will often carry out a 'skin sparing' mastectomy, whereby most of the breast skin is preserved to produce a good cosmetic outcome. All types of reconstruction are offered (implant reconstruction, latissimus flap reconstruction and D.I.E.P. flap reconstruction). These options are discussed in detail in the outpatient clinic.

Benign Breast Lumps

Sometimes these require removal. Most operations are perfomed as day-cases via cosmetic incisions.

Cosmetic Surgery

Mr. Cunnick also offers breast augmentation and breast reduction surgery. He also has experience in revisional surgery for those patients with implant-related problems, such as capsule formation and silicone leaks. Sometimes, the assistance of a plastic surgeon is required.

Sutures

Dissolvable stitches are used routinely in each patient which avoids the need for subsequent stitch removal. Many surgeons believe that it also leaves a tidier, cosmetic scar.

In-Patient Care

Patients requiring admission overnight will be looked after by dedicated ward nurses and Breast Care Nurses. I regularly review patients post-operatively. An out-patient appointment will be made prior to discharge.