Types of surgery for breast cancer in women
Surgery is one of the main treatments for breast cancer. The operation you have depends on the size and position of the cancer and your own preference.
This information looks at two type of surgery: breast conserving surgery and mastectomy.
Wide local excision (breast-conserving surgery)
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The surgeon removes only the cancer and some of the normal looking tissue around it (the margin). This is called a wide local excision (WLE).
In early breast cancer, having a WLE followed by radiotherapy is as effective as a mastectomy. You’ll need to have radiotherapy after a WLE to make sure any remaining cancer cells are treated.
If the cancer is very small, you may need a fine wire to mark the area so the surgeon can find it more easily. This is called wire localisation.
After a WLE, most women are pleased with the appearance of their breast.
Removing a larger area of breast tissue
Some women need to have a larger area of breast tissue removed (sometimes called a quadrantectomy).
Surgeons can use different techniques to help improve the appearance of your breast if you need a lot of tissue removed. They may reshape the breast by moving the breast tissue around and reducing it in size. This type of surgery is sometimes called therapeutic mammoplasty. They may suggest you have the other breast reduced at the same time or later so both breasts are the same size.
Occasionally, they take tissue from somewhere else in the body to help reshape the breast. This is usually if you have a small breast and it’s not possible to get a good appearance using mammoplasty.
After breast-conserving surgery, the pathologist examines the tissue in the area (margin) around the cancer. If there are cancerous or pre-cancerous cells (DCIS) at the edges, you will need another operation to remove more tissue. Making sure the margins are clear reduces the risk of the cancer coming back in the breast.
If your surgeon doesn’t think another breast-conserving operation is likely to be successful, they usually recommend a mastectomy.
Removing the breast (mastectomy)
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Breast surgeons will usually try to conserve a woman’s breast whenever possible. But there are situations when they may recommend a mastectomy. This may be when:
the lump is large in proportion to the rest of your breast
there are areas of cancer in different parts of the breast
there is widespread DCIS in the breast
you have had radiotherapy to the chest before to treat another cancer, such as Hodgkin lymphoma.
If you are having a mastectomy, your surgeon will usually ask if you want a new breast shape made at the same time (immediate breast reconstruction). You can also choose to delay reconstruction until after you’ve completed treatments such as radiotherapy and chemotherapy.
If you’re not having immediate reconstruction but think you might want to have breast reconstruction in the future, it’s a good idea to mention this before you have a mastectomy. You don’t have to make a definite decision at this stage, but it will help the surgeon to plan your initial surgery.
Breast reconstruction is specialised surgery carried out by a plastic surgeon or oncoplastic surgeon (experts in breast cancer surgery and reconstruction). There are different methods of reconstruction. A new breast shape can be made using a silicone implant or with fat, and sometimes with muscle from your back or tummy.