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Surgery to remove breast cancer (breast conserving surgery)

Breast conserving surgery is treatment to remove an area of cancer from the breast. Doctors also call this type of surgery a wide local excision or lumpectomy.

The surgeon removes the area of cancer and some of the surrounding breast tissue. They leave behind as much normal breast tissue as possible.

Your surgeon may recommend this operation if the cancer is:

  • small compared to your breast size
  • in a suitable position in your breast
  • only in one area of your breast

You usually have radiotherapy after this surgery. This is to destroy any cancer cells that may still be in the breast.

This type of surgery may not be suitable if you are unable to have radiotherapy afterwards. 

The operation

During the operation, the surgeon removes the cancer and a border (margin) of normal breast tissue all around it. They might also remove some or all of the lymph nodes in your armpit (axilla). They send these to the laboratory.

A pathologist checks the border around the tumour for cancer cells. If there are no cancer cells, your report will say that there is a clear margin.

It is important to have clear margins with any surgery to remove a cancer. It means that you are unlikely to need more surgery and the risk of cancer coming back in the future is lower.

You might need more surgery if the margin around the cancer is not clear.

The scar

You will have a scar on your breast. You can’t usually see this when you wear a bra or swimming costume. You have another scar under your armpit if you have lymph nodes taken away. These scars will fade a bit over time.

Sometimes the surgeon can carry out the surgery using a cut (incision) around the dark area surrounding the nipple (areolar). In time the scar becomes less visible.

This type of surgery may not change the look of your breast too much. But in some women the breast might be smaller. The surgeon may need to operate on your other breast so that they look similar.

Your surgeon can tell you what to expect. They might be able to show you photos of what your breast is likely to look like afterwards.

Breast - wide local incision diagram

Wire guided localisation

You may have a wire guided localisation before your surgery. You may also hear this called a wire guided wide local excision. This means putting a thin wire into the breast tissue to show the surgeon the exact area to remove.

Removing lymph nodes

Cancer cells can sometimes spread into the lymph nodes close to the breast.

Diagram showing the network of lymph nodes in and around the breast

Checking the lymph nodes before surgery

You have an ultrasound scan of the lymph nodes under your arm (axilla) at the same time as having other tests to diagnose breast cancer.

You usually have a biopsy Open a glossary item of any lymph nodes that look abnormal. The biopsy is sent to the laboratory to check for cancer cells. If this shows that the cancer has spread to the nodes in the armpit, you will have surgery to remove all or most of them. You have this at the same time as your breast surgery. This is called an axillary lymph node dissection (ALND) or clearance.

If the lymph nodes look normal during the ultrasound scan, you don’t have a biopsy. But you will have a sentinel lymph node biopsy (SLNB) during your surgery.

Checking lymph nodes during surgery (sentinel lymph node biopsy)

The sentinel node is the first node that fluid drains to from the breast into the armpit. This means it’s the first lymph node the cancer could spread to.

Lymph nodes that look normal on ultrasound, are checked further by your surgeon during your operation to remove the breast cancer. This is called a sentinel lymph node biopsy (SLNB). 

A few hours before the operation, your doctor or a radiographer injects a small amount of mildly radioactive liquid into your breast close to the tumour. The radioactive liquid is called a tracer.

During the operation, your surgeon might also inject a small amount of blue dye into the breast. The dye and the tracer drain away from the breast tissue into nearby lymph nodes.

The surgeon can see which group of lymph nodes the dye reaches first. They also use a radioactive monitor to see which nodes the tracer reaches. They usually remove about 1 to 3 of these nodes. They send them to the laboratory to see if they contain cancer cells. The results can take about a week.

The dye can stain your breast slightly blue. It gradually fades over a few weeks or months. The dye may also turn your urine green for a few days.

What happens after the sentinel lymph node biopsy? 

If the lymph nodes do not contain cancer cells, you won’t need to have any more nodes taken out.

If there are cancer cells in the sentinel nodes you usually need more treatment. You may have another operation to remove most or all of the lymph nodes under your arm (axillary lymph node dissection or clearance). This is generally about 2 weeks after you get the results.

Some people have radiotherapy to the armpit to destroy any remaining cancer cells instead of surgery.

Getting the results during the surgery

In some hospitals, the surgeon gets the results of the sentinel lymph node biopsy during the operation. They can then remove the rest of the nodes if necessary and you avoid having a second operation.

Your surgeon will talk to you about this before your operation if this is the plan for you.

Lymph node sampling

Instead of sentinel lymph node biopsy, your surgeon might take a sample of 4 or more lymph nodes from under your arm to check for cancer cells. This is called axillary sampling. They might use a blue dye to help to find the nodes.

Research into lymph node surgery

Research is looking at treatment of the lymph nodes during and after breast surgery.

Radiotherapy after surgery

You usually have radiotherapy to the whole breast after having breast conserving surgery.  Your doctor will tell you how soon you can start this. If you are having chemotherapy after your surgery, your radiotherapy is usually given after chemotherapy

You may have radiotherapy to part of the breast or not at all if you have a very low risk of the cancer coming back. 

Your radiotherapist will explain in detail the benefits and risks and what is best for you.

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