Breast Cancer in women

Breast Conserving Surgery, lumpectomy or wide local excision

This is the removal of the breast lump together with some surrounding normal tissue also known as a lumpectomy or wide local excision. It removes the least amount of breast tissue, but leaves a small scar and sometimes a small dent in the breast. For most women, the appearance of the breast after a breast conserving surgery is good (see 'Body image'). The surgeon also usually removes lymph glands from under the arm to check whether any cancer cells have spread from the breast (sampling or sentinel lymph node biopsy). This helps doctors decide whether other treatment is needed. Often radiotherapy is used after breast conserving surgery to increase the chances of beating the cancer, which has meant that breast conserving surgery with radiotherapy is just as effective as having a mastectomy (total breast removal). Some women may also have chemotherapy before surgery (neoadjuvant treatment) to help shrink the cancer ready for breast conserving surgery.

Before the operation an ultrasound scan is taken under the arm (axilla) to see if the lymph nodes look clear of cancer. If it is suspected that there are cancer cells in the lymph nodes a biopsy or fine needle aspiration is done and sent to the laboratory for checking. In most cases where the ultrasound scan or the biopsy shows cancer cells the surgeon may want to remove all the lymph nodes in the armpit. This is called an axillary lymph node dissection (ALND) and is done at the same time as the breast conserving surgery. An ALND may also be done in a second operation if sampling or the sentinel lymph node biopsy in the original operation shows there are cancer cells in the lymph nodes. Whether to do a full ALND or just use radiotherapy after surgery if cancer is found in the lymph nodes is an area of clinical uncertainty and needs more investigation. It may also depend on the number of lymph nodes affected.

Sentinel lymph node biopsy is another way of checking just one or two of the lymph glands to see if they contain cancer. This would normally be done if the ultrasound scan and initial tests had looked clear. It involves injecting a tiny amount of radioactive liquid into the area of the cancer before the operation. The lymph nodes are then scanned to see which has taken up the radioactive liquid first. A blue dye is also injected into the area of the cancer during the operation. The dye stains the lymph nodes blue. The nodes that become blue or radioactive first are known as the sentinel nodes. The surgeon removes only the sentinel nodes so that they can be tested to see whether they contain cancer cells. Sentinel node biopsy reduces the chances of side effects such as arm stiffness and swelling (lymphoedema) of the arm that can occur after sampling or ALND. It can also cause less pain and does not need a drain into the wound afterwards. In some hospitals, the surgeon can get the laboratory to check for cancer in the lymph nodes while the patient is still under anaesthetic the surgeon can then continue to remove all the other nodes if necessary and avoid a second operation.

Most women who have breast conserving surgery are able to have their surgery either as a day case or with a short overnight stay. Here women discuss their experiences of having breast conserving surgery and the hospital environment.

Some women discussed the fears they had before having the operation. One woman prepared herself psychologically for the surgery, while another prepared herself physically by becoming as fit as possible.

Some women described parts of the surgery procedure, and most said they found the operation painless and straightforward. However, a few women had complications during or after surgery, such as infections. For one of these women, her hospital experience was made worse by language difficulties.

Some women found having the lymph nodes tested and waiting for results more worrying than the lumpectomy itself. Most said that test results were given by medical staff sensitively, though one woman was dissatisfied by the way news had been communicated.

Some woman had a lumpectomy followed by a partial reconstruction. One woman, who was diagnosed with breast cancer during pregnancy, had a lumpectomy three weeks after a caesarean.

One woman, who was interviewed 2 weeks after receiving her diagnosis of cancer, was awaiting surgery.

Some women praised the care they had received from doctors and nurses. One woman, however, was disappointed with her treatment and with hospital staff.

Many women discussed the post-operation check-ups they had, and several said they felt lost or unsupported when follow-up care ended. Women also talked about the friendships they had developed with other patients, which had often continued after leaving the hospital.

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Last reviewed August 2018.

Last updated May 2015.


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