A fit happens when part or all of the brain becomes abnormally irritable. If it is only part of the brain, there may just be jerky movements of part of the body — say one arm or leg— without loss of consciousness. A generalised fit involves jerking movements of the whole body and loss of consciousness for a few minutes. There may be some warning immediately before the fit in the form of strange feelings — anxiety, flashing lights, unusual smells, noises in the head or some other unusual feeling. When people come to from a fit they usually feel rather strange and tired for some hours and just want to sleep. Some part of their body may be paralysed when they first come to but this usually goes back to normal over the next few hours.

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If too much skin is removed, the skin that remains may die, and there is a risk that a skin graft will be required. Therefore, only as much skin as necessary is removed. The subcutaneous fat is kept in place to give a cosmetically acceptable scar, and to allow for the painless use of prosthesis in the bra later. It is uncertain whether or not leaving more skin to facilitate a later reconstruction of the breast is dangerous in terms of ensuring the removal of all cancerous tissue, but most surgeons will err on the cautious side in any cancer operation.

The whole breast is then removed, together with the tail of the breast which goes into the armpit, and its associated lymph nodes. If all the lymph nodes are excised, one of the chest wall muscles – the pectoralis minor – must be split or removed to allow good access to the armpit. Radiotherapy is not necessarily required, although there is controversy here. Some surgeons believe that if all the lymph nodes are removed from the armpit, radiotherapy is unnecessary and, indeed, that if it were given, there would be a risk of swelling of the arm post-operatively. Other surgeons believe that only sampling of the lowest-lymph nodes in the armpit is necessary. If the nodes are found not to be involved, then it is clear that the cancer is probably confined to the breast and radiotherapy is therefore unnecessary. If, however, the nodes are involved, radiotherapy is indicated. The decision between these two types of treatment is a difficult one, both for the patient and the surgeon, and needs to be discussed carefully.

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