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Surgery is the main treatment for DCIS.
Women are usually treated with an operation that keeps as much of the breast and its shape as possible. It’s called wide local excision (WLE).
In certain situations, a woman may be advised to have the whole breast removed (mastectomy). Some women are offered a choice between WLE and mastectomy. Your surgeon and breast care nurse will talk this over with you and answer your questions.
WLE may be the only treatment you need.
The DCIS is removed along with an area (margin) of normal-looking tissue surrounding it. Before the operation you may have a mammogram and a fine wire guided into the area to act as a marker.
Some women may have a test called a sentinel lymph node biopsy to check the lymph nodes in the armpit (see below).
After WLE some women are advised to have radiotherapy|.
After your operation, the tissue that’s been removed will be sent to the laboratory so the pathologist can examine it under a microscope. It’ll be checked to make sure that there’s an area of healthy tissue surrounding the DCIS, which is known as a clear margin.
If DCIS comes back, it’s usually in the same area, and having clear margins reduces the risk of this happening.
If there are still DCIS cells at the edges of the tissue, you’ll need another operation to have more tissue removed. But if your surgeon thinks a second operation is unlikely to clear all the DCIS cells, you may be advised to have a mastectomy.
Being told you need more surgery, especially a mastectomy, can be difficult news to hear. Support from family and friends, your surgeon or breast care nurse or support organisations can help at this time.
It can be difficult to understand why mastectomy is sometimes advised to treat a non-invasive cancer. But in certain situations it’s the best treatment and will almost certainly cure DCIS. Women having a mastectomy won’t need radiotherapy.
DCIS is treated by a simple mastectomy that removes the breast tissue. You can have breast reconstruction done at the same time. Occasionally women with a big area of DCIS who have larger breasts might be able to avoid mastectomy by re-shaping the breast.
Your surgeon may advise a mastectomy if:
Occasionally, women choose to have a mastectomy instead of WLE because it relieves their anxiety about DCIS coming back. Or they may want to avoid radiotherapy| and its possible short- and long-term side effects. However, losing a breast can affect a woman’s feelings of femininity, her sex life and her relationships. It’s important to take your time and to have all the information you need so you can make the right decision for you.
Women who are having a mastectomy usually have a test called a sentinel lymph node biopsy (see below). This is to make sure that there isn’t a small invasive cancer in the breast that has spread to the lymph nodes under the arm (see the section on the breasts|).
A sentinel lymph node biopsy is a way of checking a few of the lymph nodes in the armpit to see if they contain cancer cells. The sentinel nodes are the first ones that lymph fluid drains to from the breast, so they are the most likely to contain any cancer cells.
Women who need to have a mastectomy usually have an SLNB done during the operation. Some women having WLE may have an SLNB, usually if the area of DCIS is large and high grade|.
The nodes that are removed are examined by the pathologist to make sure there are no cancer cells. If the sentinel nodes contain cancer cells, it means there is an invasive cancer in the breast. It’s no longer DCIS.
We have a separate section on primary breast cancer|.
Removing the smallest possible number of lymph nodes (usually 1–3 nodes) reduces the risk of side effects that can occur after lymph node surgery. These include swelling of the arm, known as lymphoedema|, and stiffness of the arm.
A tiny amount of radioactive liquid, which is harmless, is injected into the breast, usually around the nipple. This can be done the day before the operation. During the operation a blue dye, which stains the lymph nodes blue, is also injected into the area. The lymph nodes that have taken up the radioactivity or become blue first are the sentinel nodes. The surgeon uses a small handheld instrument to identify the lymph nodes that have picked up the radioactivity.
Only the blue or radioactive nodes (sentinel nodes) are removed and then tested to see if they contain cancer cells.
Breast reconstruction is an operation that makes a new breast shape after a mastectomy or improves the breast shape after surgery to remove part of the breast. Women with DCIS are usually asked if they want to have breast reconstruction done at the same time as the mastectomy. Having it done at the same time might help some women cope better with the loss of their breast, and it may result in a better cosmetic appearance. It usually means a longer stay in hospital and a longer period of recovery.
Some women prefer to leave reconstruction until a later time, and others may decide not have it done at all. It depends on what’s right for you.
The aim of breast reconstruction is to match the new breast to the remaining breast as closely as possible. This can be done by using an implant, or skin, fat and sometimes muscle from another part of your body to create a breast shape.
Occasionally women with bigger areas of DCIS and larger breasts can have the DCIS removed and both breasts re-shaped. The treated breast will be smaller than before, so the other breast is reduced in size to leave a woman with a symmetrical appearance.
Your breast surgeon and breast care nurse will tell you more about the methods of breast reconstruction that will be suitable for you.
We have more detailed information about breast reconstruction|.
Content last reviewed: 1 February 2011
Next planned review: 2013
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© Macmillan Cancer Support 2013
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