Breast Cancer Surgery

Wide local excision (lumpectomy)

Wide local excision — also called a lumpectomy — removes the cancer while keeping the rest of the breast intact. For most early breast cancers, it offers the same long-term survival as mastectomy — and at Breastory, oncoplastic techniques mean the cosmetic result is protected as standard. Dr Fiona Tsang-Wright (GMC 4549831), Consultant Oncoplastic and Reconstructive Breast Surgeon, operates privately in London and Buckinghamshire at the Women's Health Centre – Harley Street, Women's Health Centre - King's Road, and The Chiltern Hospital, and as NHS Consultant at Bucks Breast Unit, Buckinghamshire Healthcare NHS Trust.

Decision 1
Am I suitable?
Decision 2
Which technique?
Decision 3
After surgery

Quick answers

Is it as safe as mastectomy?

For early breast cancer, yes. Survival rates are the same when lumpectomy is combined with radiotherapy.

Will I need radiotherapy?

Almost always. Radiotherapy after breast-conserving surgery is standard and significantly reduces the risk of the cancer returning locally.

What are oncoplastic techniques?

Methods that reshape the breast as part of the cancer operation — used to preserve a natural appearance when more tissue needs to be removed.

How long is the recovery?

Most patients are comfortable within a week. Return to normal activities in 2–4 weeks; radiotherapy starts around 4–6 weeks after surgery.

01
Decision 1 of 3

Am I suitable?

Standard
Simple wide local excision

The cancer and a rim of healthy tissue are removed; the breast is closed without reshaping. Suitable for smaller cancers in breasts where the cosmetic result can be preserved without further technique.

Commonly chosen
Oncoplastic lumpectomy

The cancer is removed and the surrounding breast tissue is reshaped to fill the space. Allows a larger excision without leaving a visible defect — the standard approach at Breastory for most lumpectomies.

Larger cancers
Therapeutic mammoplasty

The cancer is removed using a breast-reduction pattern of incisions — effectively a reduction and a cancer excision in one operation. Often combined with a matching reduction on the other side for symmetry.

The type chosen depends on the cancer, your anatomy, and your preferences. This is a detailed conversation at consultation, with written information to take home — not a decision made on the day.

03
Decision 3 of 3

After surgery

Immediate reconstruction is done at the same operation as the mastectomy — you wake up with a reconstructed breast. Most patients without planned radiotherapy are candidates.

Delayed reconstruction is done months or years later, once adjuvant treatment (particularly radiotherapy) is complete. Radiotherapy can affect reconstruction outcomes — particularly implants — and in some cases a delayed approach gives a better long-term result. This is a case-by-case discussion.

At a glance

The operation

Anaesthetic General
Duration 1–3 hours
Hospital stay Usually 1 night
Recovery 2–4 weeks
Radiotherapy Almost always required
Scar Minimal, hidden where possible
  • Anaesthetic: general anaesthetic. You are asleep for the whole procedure.
  • Length of operation: typically 60–120 minutes, longer if an oncoplastic reshaping or a sentinel lymph node biopsy is included (and it usually is).
  • Hospital stay: most patients go home the same day or the morning after.
  • Incisions: placed to be as discreet as possible — usually following natural skin lines or along the edge of the areola, with the precise location planned at consultation.
  • Associated procedures: for invasive cancers, we usually perform a sentinel lymph node biopsy at the same operation to check whether the cancer has spread to the lymph nodes under the arm. If a lymph node was already shown to contain cancer before surgery, the plan for the armpit will be different — your individual axillary plan is discussed at consultation. Sentinel node biopsy is not routinely needed for women having breast-conserving surgery for DCIS (non-invasive cancer).
  • Drains: often not needed for straightforward lumpectomy; may be used for larger oncoplastic procedures.
After surgery

Recovery

Week 1
Rest and wound care

Most patients are comfortable with regular paracetamol and ibuprofen. Gentle arm movement from day one. Drains rarely needed for lumpectomy alone.

Weeks 2–4
Wound review and results

Wound check; any external clips removed. Pathology results usually back within 2 weeks, confirming whether the margin is clear.

Weeks 4–6
Radiotherapy begins

Radiotherapy usually starts 4–6 weeks after surgery and runs for 1–3 weeks depending on the protocol. Chemotherapy, if recommended, usually precedes radiotherapy.

Ongoing
Annual follow-up

Annual mammogram and follow-up with the breast and oncology teams.

Follow-up appointments are at two weeks, six weeks, three months, six months, one year, and then annually.

What the operation does

A wide local excision — commonly called a lumpectomy and also known as breast-conserving surgery — removes the cancer together with a rim of healthy tissue around it, while leaving the rest of the breast in place. It is the most common operation for early breast cancer in the UK, and for the cancers it is used to treat it offers the same long-term survival as mastectomy.

The aim is twofold: remove the cancer completely (a clear margin of healthy tissue all the way around) and preserve a natural, symmetrical-looking breast. Oncoplastic techniques — which reshape the breast as part of the cancer operation — are used routinely at Breastory to protect the cosmetic outcome, particularly where the cancer is larger, deeper, or in a part of the breast that would otherwise leave a visible defect.

Who it’s suitable for

Breast-conserving surgery is usually suitable when:

  • The cancer is confined to one area of the breast (not multifocal across widely separated areas)
  • The cancer is small enough, relative to the size of the breast, that removal leaves enough tissue for a good cosmetic outcome
  • Radiotherapy after surgery is safe for you (breast-conserving surgery almost always requires radiotherapy afterwards)
  • You are willing and able to attend radiotherapy appointments

Breast-conserving surgery may not be the right choice — or may not be your preference — when:

  • The cancer is large in relation to the breast
  • There is more than one cancer in separate areas of the breast
  • You cannot have radiotherapy (for example because of prior radiation to the same area)
  • You prefer a mastectomy for personal, genetic, or follow-up reasons

Neither option is “better” — they are different, and for the cancers that can be treated with either, the long-term survival is the same.

Oncoplastic techniques — why they matter

A simple lumpectomy removes the tumour and closes the gap. In a small cancer in a large breast, that may be all that is needed. When a larger proportion of the breast volume needs to be removed (often quoted as around 20% or more in specialist practice, though thresholds vary) — or when the cancer sits in a cosmetically sensitive part of the breast (for example near the cleavage or just below the nipple) — a simple excision risks leaving a visible dent or distortion. In these cases an oncoplastic reshape is planned from the start.

Oncoplastic techniques solve this by reshaping the breast as part of the same operation:

  • Oncoplastic lumpectomy with local tissue rearrangement — the surrounding breast tissue is mobilised and reshaped to fill the defect.
  • Therapeutic mammoplasty — the cancer is removed using a standard breast-reduction pattern of incisions, so the operation is effectively a reduction and a cancer excision in one. Often combined with a matching reduction on the other side for symmetry.
  • Volume-replacement flaps — a small flap of tissue from elsewhere (for example from the side of the chest) is used to fill the defect.

These techniques allow bigger excisions to be done without losing shape, and they often let breast-conserving surgery be offered to women who would otherwise have been advised to have a mastectomy.

Margins and re-excision

Every specimen is examined under the microscope after surgery to confirm that the cancer has been removed with a clear margin of healthy tissue all the way around. In UK practice, around 15–20% of women need a small follow-up operation (a re-excision) because the microscope shows the cancer was a little too close to the cut edge in one place. This is a known and expected part of breast-conserving surgery, not a sign that anything has gone wrong. We will discuss this with you before your first operation so it is never a surprise. If a re-excision is needed, it does not change the long-term outcome of your cancer treatment

Re-excision is discussed openly at your first consultation so it is not a surprise if it is needed. A re-excision does not change the long-term outcome of your cancer treatment, provided the second operation achieves a clear margin. It is a standard and expected part of breast-conserving surgery.

What happens after surgery

  • Histology MDT review — the final pathology (cancer type, grade, receptor status, margins, lymph nodes) is discussed at a multidisciplinary team meeting.
  • Adjuvant treatment plan — radiotherapy almost always, and sometimes chemotherapy, hormone therapy, or targeted therapy depending on the cancer’s biology.
  • Follow-up — clinic review at two weeks and six weeks after surgery, then annual mammography (and MRI where indicated) for surveillance, with clinic review at least annually for the first five years and then as agreed.

Common questions The questions patients ask first

Is a lumpectomy as good as a mastectomy for early breast cancer?
For the cancers that are suitable for either operation, the long-term survival is the same. Lumpectomy with radiotherapy is the standard of care for most early invasive breast cancers in the UK because it preserves the breast without compromising outcome.
Will I need radiotherapy after a lumpectomy?
Almost always, yes. Radiotherapy after breast-conserving surgery reduces the risk of the cancer coming back in the same breast. The radiotherapy course is usually 1 week of daily treatments (5 fractions), sometimes 3 weeks depending on the clinical situation. Some women aged 65 and over with small, low-risk, hormone-sensitive cancers can safely avoid radiotherapy, provided they take 5 years of hormone (endocrine) tablets. This is a personalised decision and we discuss it fully if it applies to you.
What happens if the margins are not clear?
A re-excision — a second, smaller operation — is planned to remove the affected edge. This is discussed before your first operation and is a standard part of achieving complete clearance; it does not change the long-term prognosis.
How long will I be off work?
Most patients with desk-based work return at 2–3 weeks. Physically demanding work, or work requiring heavy lifting, may take 4–6 weeks. This is discussed individually based on your operation and your job.
Will my breast look different afterwards?
Most patients have a good cosmetic outcome, particularly with oncoplastic techniques. There will be a scar, and the breast may look or feel slightly different from the other side. Planning at the consultation — and sometimes a symmetrising procedure on the other breast — is used to minimise asymmetry.
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