Wide Local Excision (often called Lumpectomy/Breast conservation therapy)
Involves removing the breast cancer with a rim of healthy breast tissue around it. This almost always followed by radiotherapy to complete treatment.
Wide Local Excision and Breast Reshaping
Wide local excision leaves a cavity in the breast where the tissue was removed from. This cavity, if left is usually obvious and often leads to a permanent change to the shape and feel of the remaining breast. Radiotherapy treatment may also make these changes worse. In general, the larger the amount of tissue removed and the smaller the breast it is taken from, the greater the chance of noticeable deformity. Excisions from the upper and inner halves of the breast are more likely to leave cosmetic problems than those taken from the lower and outer halves of the breast.
It is usually possible pre-operatively to predict which patients will have significant deformity. Breast Reshaping is a modern oncoplastic technique which involves freeing up the breast tissue and skin surrounding the excision cavity. Using simple techniques it is usually possible to repair and sculpt the breast to at least reduce if not eradicate the cavity completely.
Incision and Scars Placement
Depends on the site of tumour, size of breast, patient preferences and co-morbidities, smoking
1.Over the tumour- Traditional approach where the cut is made directly over the tumour. This is the easiest and quickest approach but often leaves with an unsatisfactory scar position.
2. Around the nipple (circum/peri- areolar approach)
3. Lateral/Inframammary scars
Risks and Complications-
1. Infection- Usually presents with redness, increasing pain and swelling, generally feeling feverish and unwell.
2. Bleeding- chance of around 2 in 100 which may need return to theatre.
3. Scar- which can be painful and numb long term.
4. Asymmetry- Both breasts will look different.
5. Positive margins needing further surgery- It is essential that the cancer is completely excised with clear margins, so that the risk of recurrence is reduced to a minimum. If there is evidence of further disease at the edges or margins of the tissue removed, then another operation known as a Re-Excision is required a few weeks later. Further cancerous (or more often precancerous) change at the margins of a wide local excision may be found in up to 20% of patients. The reason why it is not possible to prevent some patients from needing a re-excision, is that there can be undetectable changes in the tissue around a cancer that cannot be palpated or seen with mammograms or ultrasound before surgery. Sometimes a re-excision may not be possible or advisable and a mastectomy (removal of all the breast tissue) may be the safest option.
6. Delayed wound healing which can delay further treatment like radiotherapy and chemotherapy.
7. Change in nipple sensation and nipple necrosis- if incision is made around the nipple.
8. General anaesthetic risks- chest infection, clots in legs lungs and other systemic complications.