What do you want to know about your surgery?

What are the implications of losing a breast or both breasts? Will it be painful? How long will I take to recover? When I get back to my normal day to day activities? Will I have scars? These are the questions that follow once a patient knows that they will need a mastectomy. People respond to the news of needing a mastectomy in many various ways. Some people want it as soon as possible, others delay as they are not sure that it is the right thing to do or they may be anxious or nervous about it. Everyone is different.

What are the implications of losing a breast or both breasts?

When you research a mastectomy it is very easy to become anxious. Whether about the operation, recovery or what you will look like after the surgery. Many people, organisations, doctors and surgeons will write about the topic but unfortunately what you read is not always accurate and can cause mixed emotions. The best way to understand the process is to listen to your options from your surgeon and to meet and talk with a person that has been through a similar experience or had a similar operation.

Will it be painful?

Very often there is more emotional than physical pain after a mastectomy. It is something new that one has to get used to. It takes time and everyone will go through their own recovery at their own rate. You may be happy, sad, teary or relieved. A whole wave of emotions may follow after having a mastectomy.

How long will I take to recover?

This will depend on the person, the type of operation and the circumstances that surround the patient. It takes a good few weeks to recover from a breast operation but again the emotional side may take longer than the physical side. Getting back to day to day activities will gradually increase and become easier with time. It is important to take time to recover and to not do too much too soon. If you rest in the beginning your recovery tends to be quicker. If you are very busy straight after your surgery and do not give yourself time to recover, the patient will tend to have a lot more aches and pains that may continue for a lot longer than usual.

Will I have scars? The answer is yes. If you have an operation, you will have a scar. Scars however, do not have to be associated with something bad. There are ways to minimise scars and each surgeon will have their own way of looking after wounds and scars. The emotional scars on the other hand may remain for quite some time. As we are all different, we will all heal in different ways. It is very important to ask for help if you need it. Whether speaking to a fellow patient, a psychologist, your GP or your medical team, it is important to communicate. It is a natural feeling to be anxious regarding a pending operation and even after the operation it remains important to communicate. Therefore speak to someone before your operation and have that person as a support during your operation and after your operation as you recover. Recovering mentally is a process that starts from the time that you are diagnosed.

Most importantly, try to stay positive! Surround yourself with positive, happy and supportive people that make you feel good. Do not be afraid to ask for help when you need it! A little bit of support goes a long way when needed.

Sr Lieske Wegelin

ABC - Advocates for Breast Cancer - Breast Course 4 Nurses

BIOPSY BASICS: What a Biopsy Reveals

Advocates for Breast Cancer: Biopsy Basics

In our last blog we explained what a biopsy is, the 3 different kinds of biopsy that can be performed – as well as what to expect if you are going to have one done. But what exactly will the doctor be looking for when the results come through?

From an advocacy aspect, the same diagnostic tools are used in both the Public and Private sector in South Africa – and a management decision is made by a team of specialists using all the information they can get. eg. (This will include the size of the tumour and whether it has moved into the lymph system.)

If the biopsy results show the presence of cancer, the doctor will also be able to see exactly what kind of breast cancer you have. And because there are so many different types of breast cancer, a wide variety of treatment options are available.

In terms of our goal of lobbying government to create an implement an effective and equitable BREAST HEALTH POLICY, this is an important fact to note: malaria or TB are ‘single’/simple diseases which only need one kind of treatment — thus making them more ‘affordable’ diseases for the government to manage, as opposed to the complex — and expensive — variety of breast cancer treatments!

The biopsy results help the surgeon and the oncologist to decide on the right treatment for the right patient at the right time. Tumours can be separated into 4 main types based on their ‘histological’ type (i.e. the type of tissue where the cancer originates), the grade of tumour (how fast it is growing) and whether the breast cancer cells have receptors for the hormones, oestrogen and progesterone. These hormone receptors are proteins (found in and on breast cells) which pick up hormone ‘signals’, telling the cells to grow.

Therefore, a cancer is called oestrogen-receptor-positive (ER+) if it has receptors for oestrogen. A cancer is progesterone-receptor-positive (PR+) if it has progesterone receptors. This means: cancer cells can receive signals from hormones which could make them grow faster.

***FACT: about 2 out of every 3 breast cancers test positive for hormone receptors.***

Her-2-neu Oncogene: A biopsy will also tell the doctor about the cancer’s Her-2-neu oncogene status — i.e. if there is a genetic link to the type of cancer you have. (Watch the video below for an excellent visual summary of Her-2-neu.)


Guest post by Dr Judith Whittaker, consulting pathologist.

Dr Judith Whittaker - Oncologist

What is a Tissue Biopsy?

Advccates for Breast Cancer - South Africa - Types of Biopsies

One of the things that could happen as part of the breast cancer diagnosis process is that the doctor may ask for a tissue biopsy.

‘Tissue‘ is one of those words that can be confusing, especially if English is not your first language. In medical terms, tissue is the name given to a group of cells that perform the same function.

For a biopsy, a small sample of tissue will be taken from your body so that it can be examined more closely, deeply and thoroughly. (In many cases, an operation isn’t needed for a sample to be taken.)

The  type of tissue that needs to be removed and where it is situated in your breast will determine what type of biopsy you will need.


  1. The doctor may use a fine needle attached to a syringe (see below) to remove a small amount of tissue from the suspicious area – called fine needle aspiration. (The needle is so thin that you’ll very little.)Advocates for Breast Cancer - South Africa - fine needle aspiration - FNA
  2.  If the doctor needs a larger amount of tissue, a core needle biopsy may be done which uses a fatter, hollow needle. As a result, this type of biopsy is somewhat more paintful, but be assured the area will be numbed before insertion of the needle. Whilst tenderness and/bruising typically occur after the procedure, no scarring occurs.
  3. Sometimes a surgical biopsy may be needed which can be done under either local or general anaesthetic, depending on where in the breast the lump actually is. (A whole lump can sometimes be removed for examination.)

TAKEAWAY: What happens to the tissue after it’s been removed from the breast? We found this fantastic explanation for you: The Journey of a Tissue Biopsy!

***ALSO: Here is a Biopsy FACT SHEET to download and print!


The Waiting Game

“Waiting for the fish to bite or waiting for wind to fly a kite. Or waiting around for Friday night or waiting perhaps for their Uncle Jake or a pot to boil or a better break or a string of pearls or a pair of pants or a wig with curls or another chance.”

– Dr Seuss


“When, as a woman, sister and mother, you hear about ‘waiting time‘, I automatically think about waiting for something to happen at its own pace and time. This ‘something’ can be anything: from waiting for a load of washing to be done, waiting for a cake to bake, waiting in the supermarket check-out queue – or even just waiting for your children to finish a simple task!

Breast Cancer - waiting time - Advocates for Breast Cancer blog

The specific sort of ‘waiting time’ I want to unpack is this one: right from the moment you discover a lump in your breast, to the time it takes for you to get to your doctor for an examination and obtain an absolute diagnosis. As a woman, I know we tend to bury our own importance in the background, and will even dissolve into a kind of denial about the lump we felt. And the waiting time between the actual identification of the lump to the time it takes for an appointment with your doctor excrutiatingly increases the anxiety experienced in that time of waiting.

As a medical professional, I am acutely aware that the waiting time to see a general practitioner in the private system can range from a day to three days. The waiting time for breast-imaging may be even be as long as several days. In some of our South African provinces, the public sector’s mammographic resources are alarmingly, frustratingly and unfairly scarce – whilst some of our neighboring countries suffer even more drastically: there is only one mammography unit in Malawi! Their waiting time for breast-imaging? Months…


Another ‘waiting time’ is that endured in the doctor’s consulting rooms. In reality, one should have a ‘waiting clip-card’ which gets clipped every time someone says: ‘Please wait here for a while…’

But perhaps the most angst-filled ‘waiting time’ is between having had the mammogram and biopsy and are now waiting to hear the results from your trusted doctor. Time stands still; your heart lurches forward into a million what-ifs. This is the time when you need to have a strong, relentlessly compassionate shoulder to cry on in case the results are not what you want to hear.

Nobody likes to wait for anything – even if it is something pleasant. I have an active and very vivid imagination- and waiting gives my mind too much time to imagine all sorts of crazy things and agonize over the worst possible eventualities. PLEASE: do not do this! Wait only for a day or two, then take action and — be hopeful! Because it is inevitable you will have to wait, choose to DO something while you wait! Another action you can take (which will empower you and others) is to take up the critical cause of breast cancer advocacytell, tell, tell people about what you have experienced physically, emotionally and medically so that everyone will know just how incredibly widespread and common breast cancer is becoming, and how crucial it is that knowledge is power and early prevention is KEY! Please remember there is HOPE in early detection!

Breast Cancer - waiting time - Advocates for Breast Cancer blogSupport groups are widely available – and absolutely invaluable throughout your journey. Very importantly, being referred to the correct specialist is ultimately the best way to shorten the waiting time for a treatment plan – and pricelessly beneficial to your health!

As a final request from my heart, please always take someone with you to all your consultations.” —  Maryan Haefele (Radiographer)

Below are three of many places where you can find support – and we’ll be adding a complete list for you later this week! What’s really amazing about the variety of support groups available range from telephonic, to one-on-one sessions, group sessions and even via social media – which means that you can find the kind of support that best fits in with your practical needs and personality.


We Need Trained Health Professionals!

Mammography, ultrasounds, genetic testing… Lifestyles of the rich and the famous? Well, at least that is how many people living in South Africa feel.

Some people do not even know what a mammogram is. But is this important? Should every woman be going for screening? Why is it that in a country where imaging and treatment is available do women still present with late stage cancer?

The answer is that basic breast self-examinations (carried out by oneself) and clinical breast examinations (performed by a trained health care professional) are not actually being carried out. Yes, mammograms are relevant in certain cases, as are ultrasounds, genetic testing and various other tests and screening – but in our country it is not the answer for the millions of women that have no easy access or funding to go for these tests. Breast self-examination and clinical breast examinations are the number one “tests” that need to be carried out.

It is vitally important that if a woman finds a new lump in her breast, that she goes for a clinical breast examination. Many women in South Africa do not have access to health care facilities like hospitals as the hospitals are often very far from where the people live (and therefore expensive to travel to)  and are also often back-logged with patients. The first point of care for the majority of women in South Africa would be a clinic where a primary health care nurse would assess them.

Breast Course for Nurses - Dr Jenny Edge

The Breast Course for Nurses – one of the partner organisations that make up the Advocates for Breast Cancer –  aims to equip primary health care nurses with the knowledge to perform clinical breast examinations and to know the differences between the normal changes to the breast and changes that need to be referred. The Breast Course for Nurses was started by Dr Jenny Edge, a general surgeon from Cape Town with a special interest in breast conditions. Dr Jenny Edge and Professor David Woods, a retired neonatologist (of the PEP foundation), wrote the Breast Care book which the course is based on. (Click here to equip yourself with a copy!)

To date, courses have been completed in Cape Town, Johannesburg and Durban with courses currently running in Cape Town and Port Elizabeth. We are so excited to see what an impact this course is making! Look at the photos taken at the courses across the country here.

The Breast Course for Nurses focuses on the following topics:

  • the normal breast
  • clinical assessment of the breast
  • special investigations of the breast
  • benign changes of the breast
  • cancer of the breast
  • treatment of breast cancer
  • side effects of breast cancer treatment
  • palliative care
  • community outreach programmes

The course starts with a one day session where the first two  modules of the book are discussed. It then consists of six  months of distance learning with multiple choice questions (MCQ’s) for each module that need to be completed. The course then ends with a two day residential course where the remaining modules are discussed, wound care and palliative care are addressed and networking takes place. Practical sessions about biopsy techniques and lymphoedema therapy are carried out.

Although the core content of the course remains the same, both the input and practical sessions differ regionally depending on the needs of the nurses. The emphasis of the course is on learning rather than teaching and is primarily aimed at equipping nurses with the skills and knowledge to manage women with breast problems.

The World Health Organisation predicts that the mortality due to non-communicable diseases in the developing world will increase by 17% in the next 10 years. This will have a major impact on an already overburdened system.

Primary health care nurses will remain the first point of contact for many women as time goes on. The Breast Course for Nurses aims to educate these primary health care nurses so the correct clinical examinations can be carried out and an efficient referral system can be implemented.

breast course