Lumpectomy (wide local excision): what happens, risks and recovery

Wide local excision is a form of breast-conserving surgery. The aim is to take out the cancer, or the area of ductal carcinoma in situ (DCIS), with a margin of normal tissue so that the breast itself can stay. The NHS describes breast-conserving surgery as removing only the cancerous area, as opposed to a mastectomy, which removes the whole breast.

One Oxford leaflet lists the situations in which it is usually recommended: the cancer is small compared with the size of the breast, it sits in a suitable position, and it has developed in one area only. Choice matters too. If, after talking it through with your surgeon and breast nurse, you prefer it, that is a recognised reason to go ahead.

It is not always the right operation. A larger cancer, several separate areas of cancer, or a breast that would be left badly misshapen may point towards a mastectomy or an oncoplastic technique instead. Both Oxford and Birmingham leaflets name mastectomy as a possible alternative, and Birmingham also mentions oncoplastic procedures such as mammoplasty.

Before admission you are usually seen at a pre-assessment clinic. The Birmingham leaflet lists a physical examination, blood and urine tests, MRSA screening and sometimes a heart tracing, and says the visit can take two to three hours. The aim is to check you are fit for a general anaesthetic and to sort out your regular tablets, since the team will tell you which to take and which to leave out on the day.

Fasting is the part people most often get wrong. Several leaflets say to stop eating about six hours before surgery, and Oxford adds that sips of water are allowed until two hours before. Use the instructions on your own appointment letter, because hospitals vary.

• Bring a list of every medicine you take, including anything bought over the counter.

• Remove make-up, nail varnish and jewellery other than a wedding ring, as Birmingham asks.

• Expect to wear compression stockings, and possibly to have a daily anti-clotting injection for about a week, to lower the chance of a leg clot.

• Arrange a lift home and, if you live alone, someone to be with you at first.

You will see the anaesthetist and surgical team, and the side being operated on is marked. Under general anaesthetic the surgeon removes the cancer with its margin through a cut in the breast.

In most cases an operation on the armpit lymph nodes is done at the same time. Birmingham names three types: node sampling, node clearance and sentinel lymph node biopsy, and the surgeon decides which suits you. Some patients have a thin drain tube left in the wound for a short time.

The wound is closed with stitches that dissolve. Oxford describes stitches under the skin with paper strips or glue on top, and a typical hospital stay of six to eight hours. Birmingham says most people go home the same day after a short recovery period, and a person who lives alone may be kept in overnight or asked to arrange company.

The removed tissue goes to the laboratory. If the edges are clear of cancer cells, no further surgery is needed on that area. If cancer cells reach the edge, a second operation, which Birmingham calls a cavity shave, may be advised to remove the rest. Oxford adds that a second operation may occasionally lead to a mastectomy.

The result also shapes what comes next. According to the Birmingham leaflet, radiotherapy is commonly given after wide local excision, and other treatments to lower the risk of recurrence can include anti-oestrogen tablets, chemotherapy and anti-HER2 treatments. These are decided at the clinic once all of the results are available, which is why many people prefer to wait for them before planning a return to work.

The leaflets describe complications as uncommon and seldom serious, and none of those retrieved quoted percentages, so none are given here. Birmingham lists bleeding, infection, swelling, numbness or pins and needles around the scar, pain and thrombosis. Mild swelling and bruising can take four to six weeks to settle completely.

A seroma, a collection of fluid under the wound, is described by Oxford as quite common after breast surgery and not harmful. It can be drained by the specialist nurse if it becomes painful, although letting it reabsorb is preferred when possible. Worcestershire also lists a haematoma, which is a collection of blood that occasionally needs a further procedure, and a change in how the breast looks or feels.

Cosmetic result is a genuine consideration. Depending on how much tissue is removed, the breast may be smaller or differently shaped, with a scar that fades with time. If this worries you, raise it with the specialist nurse before the operation rather than afterwards.

Expect to feel sore and tired for a few days and take regular painkillers. Birmingham suggests a supportive, well-fitted bra as soon as possible, and advises against elasticated crop tops because they give little support. Gentle arm exercises help keep a full range of movement, and heavy lifting and housework are best avoided at first.

Driving is allowed once an emergency stop can be made without discomfort and a seat belt is comfortable. Birmingham suggests this may be about ten to fourteen days, while Oxford advises waiting at least one week, or two if the armpit was also operated on. Your own insurer should be told about any restrictions. The week-by-week picture is set out in the recovery timeline for this operation.

Contact your breast care nurse or GP promptly if the wound becomes red, hot, very painful or starts to ooze, or if bleeding is more than a few spots on the dressing. Out of hours, NHS 111 can advise. Call 999 for sudden breathlessness, chest pain or collapse, which can be signs of a clot in the lung.