Breast conserving surgery (lumpectomy)
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 helps reduce the risk of the cancer coming back 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.
Finding cancers that are too small to feel (Occult lesion localisation)
Some early cancers are picked up through scans such as a mammogram, ultrasound scan, or MRI scan. These types of cancers may be too small for your surgeon to feel. They are called non palpable or occult lesions. Surgeons can use different ways to find the cancer so they can safely remove it.
They are split into two groups. One where you use a wire to find the cancer (wire guided localisation). The other group is called non wire guided localisation.
Your surgeon will tell you what type of technique they will use if its needed.
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. You have the wire put in while having an ultrasound or mammogram by the radiologist or breast surgeon. You usually have this done the morning of your operation.
Once asleep for the operation your surgeon makes a small cut in your breast. The wire guides the surgeon to the right place. They then remove the cancerous breast tissue with a margin of healthy tissue. They take out the guide wire when they have finished.
Non wire guided localisation
There are several different ways to find a breast cancer not using a wire. Your surgeon might use a type of marker that can show where the cancer is such as:
- a magnetic marker
- radioactive liquid or seed
- a electromagnetic wave reflector
- a radiofrequency tag
Depending on which type you have will depend on when you have it put in. Some markers are put in on the day or day before your surgery. Others you can have up to a few weeks before your surgery.
You have an ultrasound or mammogram to get the marker in the exact area that needs removing
During surgery, the surgeon uses a probe that can pick up the marker and breast tissue that needs removing.
Lumpectomy and reshaping the breast (therapeutic mammoplasty)
Some women may need a large amount of breast tissue removed which will affect how the breast looks. In this situation your surgeon may recommend a therapeutic mammoplasty.
This means your surgeon will remove the cancer and use the remaining tissue and skin to create a new breast shape. This makes the breast smaller than before. You still have your nipple and areola. You are also likely to need surgery to your other breast so it looks symmetrical.
If you have small breasts your surgeon may need to use tissue from nearby to help reshape the breast. This is called a partial reconstruction. Your surgeon will talk to you in detail before the surgery about the procedure and what to expect.
Removing lymph nodes
Cancer cells can sometimes spread into the lymph nodes close to 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 
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)
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).
The sentinel node is the first lymph node in the arm pit where the fluid from the breast drains into. This means it’s the first lymph node the cancer could spread to.
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 blue dye reaches first. They also use a radioactive monitor to find out 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. You may have this if the radioactive tracer and blue dye injections haven’t worked or couldn’t be injected.
Research into lymph node surgery
Research is looking at treatment of the lymph nodes during and after breast surgery.
Possible problems after breast conserving surgery
There is a risk of problems or complications after any operation. Treating them as soon as possible is important. Some of the problems include:
- bleeding from the wound
- infection
- fluid collecting around the operation site (seroma)
- blood collecting around the operation site (haematoma)
- nerve pain
- shoulder stiffness
- swollen arm or hand
- scar tissue in the armpit (cording) if you have had lymph nodes removed
blood clots
Follow up after surgery
You have follow up appointments to check your recovery and sort out any problems. They are also your opportunity to raise any concerns you have.
You usually see your surgeon one to two weeks after your operation. They examine you and check your wound is healing well.
Your surgeon will explain the results of your surgery and talk about any further treatment you might need.
You'll have contact details for your breast care nurse or the ward if you need to contact someone before your follow up appointment.
Supported self management or patient initiated follow up (PIFU)
In some hospitals you might have regular phone calls with your breast care nurse instead of seeing your doctor in clinic. You can also contact them between appointments if you have any new symptoms or are worried about anything. They can then arrange for you to be seen in clinic.
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, you usually have the radiotherapy after chemotherapy.
Certain hospitals may offer radiotherapy to part of the breast during surgery. This is called intra-operative radiotherapy. Or you may not have radiotherapy at all if you have a very low risk of the cancer coming back.
Some people who have a higher risk of cancer coming back may have extra radiotherapy. This is called a radiotherapy breast boost. A boost is extra amounts (doses) of radiotherapy targeted at the area in the breast where the cancer was removed. You might have this if you have had your whole breast treated with radiotherapy after breast conserving surgery.
Your cancer specialist will explain in detail the benefits and risks of radiotherapy and what is best for your situation.
Davina's breast cancer story
Davina had a lumpectomy and lymph nodes removed.
“I’m getting stronger every day by doing the exercises I was shown at the hospital.”
