Case recorded: 15 February, 2009
Dr Sing Kong Yuen, BVMS (Glasgow), MRCVS

5 months ago, the womb was infected with pus (pyometra) and removed. Can the vet deliver?	5 months later. A breast tumour involving the nipple grows fast and increases in size over the past 2 weeks.
The breast tumour was inflamed and firm. Surgery (mastectomy) was done the next day as the tumour seems to be more than doubling its size every week! This indicates malignancy of the breast tumour and no time should be wasted in delaying the surgery. If your vet has no time, get another vet to do it.	MASTECTOMY. As the tumour was nearly 1 cm, the cutting of another 1 cm of breast tissue from the edge of the tumour meant that there was a large hole of 4 sq cm. The actual cut was 2 cm wide and 3 cm long, making the 6 sq cm hole terribly large.

"I was busy doing voluntary work," the owner explained when I asked why she delayed seeking veterinary attention. "My husband reminded me to get the dog examined but I was busy."

"It would have been so much easier to remove the tumour when it is much smaller," I knew it was not in the dog's interest to wait. "It is safer too as the dog needs not be at risk receiving longer anaesthesia."  I did not explain to her that a big breast tumour surgery meant a big hole and greater difficulty in closing the wound. The white scars of the pyometra incision of the pyometra surgery performed by me - Can the vet deliver? - was evident and part of it was pure adhesive scar under the skin. This scar did interfere with the undermining of the skin after tumour excision. Undermining the skin gives the surgeon more loose skin to catch and suture.  This was just too technical for a lay person to understand and so I did not elaborate. The rapidly growing tumour would probably be malignant. It may have spread malignant cells to other breasts or be all over the body now.

In simple explanation, a large breast tumour means a large hole (wound) in the skin and a greater difficulty in closing the wound.

Her husband had reminded her to get the dog treated but she just had no time as she was involved in voluntary work at the grass roots. So the tumour grew bigger and bigger. "Charity begins at home," I thought of this phrase.  

For this Chihuahua, isoflurane gas anaesthesia was used. No sedation as she was not in excellent health. Maintenance of anaesthesia at 1.5 - 2% was all right for her and surgical anaesthesia was achieved. The actual surgery took around 30 minutes. The shorter the anaesthesia, the less risky it is for the dog with heart disease. She woke up immediately after the last stitch as the anaesthesia was reduced to zero as the last 2 stitches were placed.

MASTECTOMY. The left Mammary Gland 3 was inflamed and hard. It would be an inflammatory tumour and therefore was best removed early. Excise 1 cm around the tumour and remove the mammary tissues. Slight bleeding from the small branches of the caudal superficial epigastric blood vessels was controlled by clamping.   

The mammary tissues removed was 2 cm x 3 cm. The 6 sq. cm hole after removal of the tumour was massive. Undermine the skin to get more loose skin to stitch. 3 subcuticular sutures were as follows: The needle entered the subcutaneous fat of the far side, then into abdominal muscles of the same side. The needle walked into the abdominal muscles of the near side and then into the subcutaneous fat. 3 horizontal mattress sutures close the skin wound. The owner wanted the dog back after surgery. Would the sutures hold?  

Some surgeries become inoperable when the tumours become massive and/or have had spread due to a delay in seeking veterinary advice.

CONCLUSION. Would the dog suffer from pyometra and breast tumour if she was spayed at 6 months of age some 9 years ago?  Nobody can predict the future. The probability of her not getting breast tumours after early spaying is higher. Obviously, there would be no pyometra (infection of the womb) if she was spayed at a young age. Time must be given to your older dog by checking for breast tumours daily and getting them removed by your veterinarian when they are very small. Malignant breast tumours usually double in size every week. I had cases where they become twice the size of golf balls before the owner seek advice. In such cases, it was too late. As some owners in Singapore feel that it is cruel to sterilise the dog, I do not advise further in such cases.    

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All rights reserved. Revised: February 15, 2009
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