Breast cancer surgery

Breast-conserving surgical procedures aim to remove the cancer while keeping as much of the breast tissue as possible. 

Breast-conserving surgery (lumpectomy / wide local excision)

Breast-conserving surgery, which is also called wide local excision or lumpectomy, removes the area of cancer along with a margin of healthy surrounding tissue. The aim is to remove the cancer completely while preserving as much of the breast as possible.

If your surgeon recommends a lumpectomy, you will usually need a course of radiotherapy afterwards to reduce the risk of your cancer returning. Your consultant will discuss this with you before your surgery and will be able to answer any questions you may have. 

Wire-guided local excision

Wire-guided local excision is typically used when a tumour has been identified through screening but may be too small to feel, or difficult to locate and visualise during surgery.

Before the operation, a fine wire or marker is inserted into the breast - guided by ultrasound or mammogram imaging - to mark the area of tissue to be removed and ensure the cancer is removed precisely. Our imaging and surgical teams work closely together to plan this precisely, helping to ensure as much healthy breast tissue as possible is preserved.

Oncoplastic breast surgery

When resection of the tumour may lead to a predictable size discrepancy or localized volume deficit, our team of surgeons can guide you with possible options to optimize breast form and symmetry. These techniques use adjacent tissue from within the breast or adjacent to the breast to give the best possible aesthetic results after the cancer surgery. This surgery is performed at the time of the cancer resection and sometimes addresses the opposite breast to maintain symmetry.

If breast-conserving surgery is not suitable for your diagnosis, a mastectomy may be recommended. This is an operation to remove the entire breast - it’s usually recommended if the cancer is large or there are multiple areas of cancer in the breast.

Some people who are eligible for breast conserving surgery choose mastectomy as their preferred option after discussing their options with their consultant.

There are different forms of mastectomy, including skin sparing and nipple-sparing approaches, which preserve more of the breast skin to support reconstruction. Your surgeon will discuss which type of mastectomy is most appropriate for you. Our breast and oncoplastic surgeons are experienced across the full range of mastectomy techniques, and will work with you to choose the most appropriate approach for both your cancer treatment and any reconstruction you may be considering.

Breast reconstruction can be performed during the same surgical procedure as your mastectomy or at a later date. This is your choice, and your surgical team will make sure you have all the information you need.

Lymph node surgery helps your clinical team to assess whether your breast cancer has spread beyond the breast. This surgery forms both an important part of staging and treatment.

Sentinel lymph node biopsy

The sentinel lymph nodes are the first nodes that lymph fluid drains to from the breast. During a sentinel lymph node biopsy, the surgeon removes a small number of these nodes, usually one to three, and sends them to a pathologist to check for cancer cells.

If no cancer cells are found, no further lymph node surgery is needed. If cancer cells are present, your consultant will discuss whether additional lymph node surgery or other treatment is recommended.

Axillary lymph node clearance (axillary node dissection)

If cancer cells are found in the sentinel lymph nodes, or if other tests suggest the lymph nodes may be affected, your surgeon may recommend axillary lymph node clearance. This involves removing a greater number of lymph nodes from the armpit.

Axillary lymph node clearance provides more detailed information about the extent of any spread, and helps inform decisions about further treatment. 

It carries a higher risk of side effects than sentinel node biopsy, including lymphoedema (swelling of the arm), shoulder stiffness and numbness. Your surgeon and Clinical Nurse Specialist will discuss these risks with you in detail before your operation. 

Our surgical teams are very experienced in these operations, and take great care to minimise the extent of lymph node removal wherever it's clinically appropriate, helping to reduce your risk of side effects including lymphoedema. 

Restoration of lymphatic flow in patients at high risk of lymphoedema

Lymphoedema or swelling of the arm can sometimes be a consequence of treatment to the axilla for breast cancer. Modern microvascular surgery and surgery to map lymphatic flow may be suitable for selected patients and you will be able to discuss this further with your surgeon.

Reconstructive surgery aims to recreate the shape of the breast after a mastectomy. It may be performed at the same time as your mastectomy (known as immediate reconstruction) or at a later stage (known as delayed reconstruction).

Reconstruction is not right for everyone, and not every person opts for reconstruction. Your surgical team will help you understand the options and what each involves. The right approach depends on your individual circumstances, including the type of mastectomy, whether radiotherapy is planned, and your personal preferences.

Implant breast reconstruction

Implant reconstruction uses a silicone implant to recreate the shape of the breast. It is often performed using a tissue expander, which is a temporary implant that gradually stretches the skin and muscle, before being replaced with a permanent implant at a second operation.

Implant reconstruction is generally a shorter and less complex operation than reconstruction using the body's own tissue. It may be recommended if you prefer a shorter recovery, or if you do not have enough suitable tissue elsewhere. Your surgeon will talk you through the different implant options available, helping you choose an approach that best matches your goals for shape, size and recovery time.

Reconstruction with latissimus dorsi (LD) flap

The latissimus dorsi flap uses muscle and skin from the back to reconstruct the breast. The tissue is moved from the back around to the chest, maintaining its original blood supply. An implant may be used alongside this technique if more volume is needed.

The LD flap is a well-established reconstructive technique and may be recommended when implant-only reconstruction is not suitable.

Fat transfer (lipofilling)

Fat transfer, which is also called lipofilling or fat grafting, involves taking small amounts of fat from another part of the body (such as the abdomen or thigh) using liposuction, and injecting it into the breast area to improve the shape, contour or symmetry of a reconstructed breast.

Fat transfer is most commonly used to refine the results of an earlier reconstruction rather than as a standalone reconstructive technique. It may be performed as a day procedure and typically has a shorter recovery time than more complex reconstruction.

DIEP flap reconstruction (free flap / body tissue reconstruction)

DIEP flap reconstruction uses skin and fat from the lower abdomen to reconstruct the breast. Unlike the LD flap, the tissue is completely removed from the abdomen and its blood vessels are reconnected to blood vessels in the chest. This is called a free flap procedure and requires specialist microsurgical skill.

DIEP flap reconstruction creates a natural-feeling breast using the body's own tissue, without using muscle. It is a more complex operation than implant reconstruction, with a longer recovery time, but for many people it provides long-lasting, natural results. Our microsurgical teams use advanced imaging, including CT angiogram or MRI scans, to plan the blood vessels for your reconstruction in detail before your operation. This careful planning helps to improve outcomes and reduce complications.