Lumpectomy (wide local excision) for breast cancer: what to expect

A lumpectomy removes a breast cancer, or an area of ductal carcinoma in situ (DCIS), together with a margin of normal tissue around it, while the majority of the breast is kept. The Worcestershire Acute Hospitals leaflet describes wide local excision as removal of the affected part of the breast together with a clear margin all around, as the surgical treatment for breast cancer or DCIS.

The NHS lists three main surgical approaches for breast cancer: removing only the area of the breast with cancer in it (sometimes called breast-conserving surgery), removing the whole breast (a mastectomy), and removing lymph nodes in the armpit, which are small glands that are part of the immune system. A lumpectomy belongs to the first group. The name partial mastectomy is also used for removal of part of the breast in this way, so ask your team exactly how much tissue is planned to be removed.

The type of surgery you are offered depends on factors such as the size and type of the cancer, where it is, whether it has spread and your general health, which the NHS names as the factors that shape the whole treatment plan. Your specialist team explains the options and benefits and side effects and works with you on a plan.

Before admission you may be asked to complete a health questionnaire, and some people are invited to a pre-operative assessment clinic where nurses confirm medical information, medicines and allergies and may arrange blood tests, an X-ray or heart or lung tests. The Worcestershire leaflet says you will be asked not to eat or drink for six hours before the operation, with a few sips of plain water allowed up to two hours before to take tablets, and to continue your usual medicines unless told otherwise. Tell the team if you take blood thinners.

The Bath leaflet describes the operation as removal of a breast tumour that can be easily felt, and the same unit lists needle-localised wide local excision as a separate operation, so ask your team whether any marking procedure will be needed before surgery in your case.

The leaflet also suggests that smokers consider giving up for several weeks before the operation, since smoking reduces the amount of oxygen in the blood and increases the risk of breathing problems, and that losing weight reduces anaesthetic risks if you are overweight.

The Royal United Hospitals Bath leaflet explains that the operation involves an incision in the skin of the breast, in general sited over the tumour itself or at the margin of the areola. The surgeon dissects underneath the skin and removes the tumour with a rim of normal breast tissue surrounding it. It is done under a general anaesthetic and takes in the region of 60 to 90 minutes.

Lymph nodes in the armpit may be removed or sampled at the same time if needed. The Bath leaflet describes combining the lumpectomy with a sentinel lymph node biopsy, in which case you should be able to go home on the same day or the day after. All of the tissue removed is examined under a microscope, and the findings guide what further treatment is recommended.

The wound is usually closed with dissolvable stitches, surgical glue or paper stitches, according to the Worcestershire leaflet, which advises keeping the wound dry for the first 48 hours and then bathing or showering as usual without soaking the dressing.

The Worcestershire leaflet describes general risks of surgery, including wound problems such as infection and blood clots in the legs or occasionally the lung, and risks specific to breast surgery. These include swelling, which usually settles over a few months, a seroma (a collection of fluid under the wound that may need to be drained with a needle and syringe in outpatients), a haematoma (a collection of blood that may occasionally need an operation to remove), and minor skin burns from the heat used to stop bleeding.

Both leaflets say the appearance of the breast may change. The Bath leaflet says the size, shape and contour of the breast may be altered somewhat, and that the breast may be quite bruised and swollen at first. The Worcestershire leaflet adds that the amount of change depends on the volume of tissue removed and your original breast size, and that altered sensation in the skin of the breast is not uncommon and usually improves with time. Most people will not experience serious complications, but the risks are higher in older people, those who are overweight and people with heart, lung, diabetes or kidney conditions.

The removed tissue is checked in the laboratory to see whether there is a clear margin of normal tissue all around the cancer or DCIS. If the margin is not adequate, the Worcestershire leaflet says further surgery may be needed, which will be discussed at your follow-up visit. The Bath leaflet says the chance of the tumour proving larger than anticipated and of needing more surgery is approximately 20 to 30%.

The Bath leaflet says further surgery would be suggested to the breast to achieve an adequate margin of excision. The NHS lists removal of the whole breast (mastectomy) as another form of breast cancer surgery, so it is sensible to talk through the possibilities with your team before the first operation.

After a lumpectomy for breast cancer, the NHS says radiotherapy is used after surgery to lower the chance of the cancer coming back. The Bath leaflet states that, as long as the tumour has been adequately excised, patients are normally offered a course of radiotherapy to the breast. The NHS also lists chemotherapy, hormone therapy and targeted medicines or immunotherapy as treatments that may be used before or after surgery depending on the type of breast cancer.

You will have regular check-ups during and after treatment, and the NHS says that if you have symptoms or side effects that worry you, you should talk to your specialists rather than wait for your next check-up.

The Worcestershire leaflet says full recovery varies from person to person and may take up to 3 to 4 weeks, and suggests thinking in advance about who can help in the early days. Arm and shoulder exercises from the information pack can start on the second day after the operation to help keep the shoulders supple, and a daily walk is encouraged.

You should not drive until you feel confident that you could perform an emergency stop without discomfort. The leaflet says you can usually begin gentle work within a week or two but may need to wait longer before more vigorous activity, and that sexual activity can resume when you feel comfortable. It also notes that feeling low after an operation is not uncommon and that breast care nurses can help with psychological support.

If your symptoms worsen or you are concerned about the wound, the leaflet advises calling your GP, 111 or 999 as appropriate, and the breast unit contact on your discharge paperwork for specific questions.

On the NHS, a suspected breast cancer is assessed in a breast clinic, and treatment is planned by a specialist care team, as the NHS describes, and the Worcestershire leaflet mentions breast care nurses as a source of support. NHS treatment is free at the point of use.

Some people choose to be seen privately, often for quicker appointments or for a particular surgeon. The principles of the operation and the pathology tests are the same. It is reasonable to ask which team will manage radiotherapy and follow-up, who you should contact after discharge and what happens if the margins prove inadequate.