Integrated Cancer Care

Panorama Centre For Surgical Oncology

Procedures

Breast Procedures

A lumpectomy means the removal of the part of the breast containing the cancer.  No muscles are removed.   This may be combined with removal of some lymph nodes from the axilla.  This operation is done when it is possible to treat breast cancer without removing the whole breast .  It is  usually followed by irradiation.  

Indications:

Both infiltrating cancer and in-situ cancers could potentially be managed with lumpectomy. 

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Oncoplastic lumpectomy combines the plastic surgery technique of a breast reduction with lumpectomy surgery to give you a better cosmetic outcome after the cancer is removed.

You can think of oncoplastic lumpectomy,  also called oncoplastic surgery, as a doing a breast reduction operation and including the cancer in the area to be removed while moving the remaining tissue into position to create a normal but more compact breasts mound.

There are many different oncoplastic approaches available to reshape the breast after removing the cancer and in our unit, almost every lumpectomy will have some local tissue transposition to prevent a permanent defect.

Read more about oncoplastic surgery.

Mastectomy is the removal of all breast tissue. There are different types of mastectomy.

The traditional “simple” or “total” mastectomy is a procedure where skin, nipple and breast tissue is removed. This is them closed with a diagonal of horizontal scar leaving a flat chest. 

A Skin sparing mastectomy is where the breast tissue under the skin is removed, but at least some of the skin is retained. With a Skin- and Nipple sparing mastectomy the nipple is retained as well. This facilitates reconstructive options either immediate or at a later time. 

Any of these options can be combined with procedures to the lymph nodes

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Head and Neck Operations

What to Expect During a Thyroid Lobectomy

A thyroid lobectomy is used to remove one of your two thyroid lobes, leaving the other intact. We may perform this type of surgery if there are nodules that cause symptoms or could be cancerous. We also use it to treat excessive hormone production like that associated with hyperthyroidism.

If you are having a thyroid lobectomy because of an indeterminate biopsy result, we will send the tissues collected to a pathologist for examination. If cancer is found, you might have to undergo a second surgery to ensure that all of the cancerous tissue is removed.

A thyroid lobectomy is performed under general anaesthesia. Some patients may go home the same day but most will spend the night in hospital.  You will require very little post-operative care and should be able to eat and drink normally as soon as you have recovered from the anaesthesia.  At home you will be able to care for yourself.

Six weeks after a thyroid lobectomy, you’ll need to have your thyroid levels checked. Depending on the results, you may need thyroid hormone replacement.

What to Expect During a Total Thyroidectomy

Total thyroidectomy involves the removal of the entire thyroid gland. This procedure is performed to treat conditions like thyroid cancer, uncontrollable hyperthyroidism or a large multinodular thyroid that causes severe symptoms.

If you’re having thyroidectomy as a result of thyroid cancer, we may remove lymph nodes around your thyroid to be examined by a pathologist. We use the smallest incisions possible, to limit scarring to your neck and deliver the best possible cosmetic results. In most patients the incision is 4-5cm long.  General anaesthesia is used during a thyroidectomy, and you’ll usually stay in the hospital for one night following the procedure.

The day after surgery we will do blood tests to check your calcium and PTH levels. PTH is produced by the parathyroid glands situated next to your thyroid and they may become underactive due to the surgery. This can lead to low calcium levels. This is usually temporary but most patients will need to take oral calcium supplements for between one and 6 weeks after surgery.

After your procedure, you will need to take thyroid hormone replacement tablets for the rest of your life, because your thyroid gland will no longer supply you with the necessary hormone. We will do blood tests to ensure that you are getting the right amount of thyroid hormone. 

In the weeks after your thyroidectomy, you may have neck pain, soreness of your vocal chords or a weak voice. These symptoms are usually temporary.

parotidectomy is the surgical removal of the parotid gland, the largest of the salivary glands. The procedure is most typically performed due to inflammatory lumps or neoplasms (tumours / Gowths) . Neoplasms can be benign (non-cancerous) (80%) or malignant (cancerous) (80%).

Anatomy

The parotid gland consists of two lobes: the superficial lobe and the deep lobe. Surgery to remove a tumour in the superficial part is called a superficial or suprafacial parotidectomy. Surgery to remove a tumour in the deep lobe or both the deep and superficial lobes is called a total parotidectomy.

The Facial nerve runs through the parotid gland between the superficial and deep lobes. 

The operation

Treating parotid gland tumours requires meticulous operating technique because the facial nerve runs through the middle of the gland. The facial nerve controls all the muscles of your face like those that make you blink,  frown and smile.

Preserving the facial nerve is an important consideration when removing the parotid gland. The facial nerve is typically identified first during the operation and constantly kept under vision while dividing the parotid tissue.  The are situations where the tumour may grow onto the nerve and complete removal of the tumour is impossible without removing some part of the facial nerve.  This will result in loss of function (paralysis) of the part of the face supplied by that part of the nerve. Options to restore function will be considered should this be the case.

Superficial Parotidectomy

  • We would normally recommend a superficial parotidectomy (surgery to remove all or part of the superficial lobe) if the tumour is confined to the superficial lobe of the parotid gland.
  • The cut (incision) required to remove the tumour begins at the front of the earlobe, curves under the ear and follows the line behind the jawline. It is generally 5-6cm in length
  • Surgery for all tumours requires removal or a margin of healthy tissue around the tumour to reduce the risk of it coming back without causing damage to the facial nerve.

Total Parotidectomy

  • A total parotidectomy (surgery to remove the deep lobe and possibly the superficial lobe) is advised when the tumour is affects the deep lobe.
  • The cut (incision) for a total parotidectomy is the same as the one for a superficial parotidectomy but may require a slightly larger cut.

Lymph Node Removal During Parotidectomy

Some parotid gland cancers may spread to the lymph nodes in the neck. Removing the lymph nodes in the neck may be necessary at the same time as the parotidectomy. The goal of this procedure is to find lymph nodes which might contain cancer and thus reduce the chance that the cancer may return in the future.

Our team

Our surgeons have extensive experience in performing these procedures and we are one of only two private units with a multidisciplinary team dealing with these conditions.

Facial Nerve Monitoring

Removing  the parotid gland,  surgeon will first need to locate and work around the facial nerve.

The complete removal of your tumor, combined with the preservation of the facial nerve, is a priority of the surgical team at Memorial Sloan Kettering. Our surgeons have extensive experience in using precise surgical techniques that help preserve the facial nerve. In addition, they use the most-advanced facial nerve monitoring technology. It allows them to find the facial nerve during the surgery. This includes the many branches of the facial nerve, which control different parts of the face. This technology helps our surgeons identify and preserve each tiny facial nerve branch.

In some cases, the facial nerve may be temporarily or, very rarely, permanently weakened due to removal of a parotid gland tumor. The risk of facial nerve weakness is directly related to the size, extent, and type of parotid gland tumor.A

Lymph node procedures

How do I become a patient at PACSO?

We believe that every patient has the right to the best treatment available with a team where they feel safe and cared for.
Phone +27 (0)21 939 7790 or email info@pacso.co.za to set up an appointment.
The more information we have about your case before your visit, the better we can prepare.

Panorama Centre for Surgical Oncology

The branch of medical practice that treats injuries, diseases, and deformities by the physical removal, repair, or readjustment of organs and tissues