Wide Local Excision

What is a wide local excision?

A wide local excision – also known as a lumpectomy – is an alternative treatment to mastectomy for treating breast cancer.  It involves removing the tumour with a cuff of normal tissue around it to decrease the chance of recurrence.  The remainder of the breast is used to close the area where the tumour was taken, in some cases, a flap of tissue from outside the breast is used instead. In most cases, a sentinel node biopsy is also performed unless you have ductal carcinoma in situ (DCIS) only with no invasive breast disease.  The sentinel node biopsy is to look for microscopic cells in the draining lymph nodes of the breast.

How is the surgery performed?

If your tumour is not able to be felt you will have a guiding wire placed by radiology on the morning of surgery under local anaesthetic. If you are having a sentinel node biopsy you will have a special tracer injected into your breast immediately prior to your operation. This tracer travels to the draining lymph nodes of the breast and allows them to be localised by your surgeon in theatre. Sometimes an injection of blue dye is also needed to find the draining lymph nodes. For the operation you will have a general anaesthetic. The incision will vary depending on where in the breast your tumour is – this will be discussed with you before the operation. You may require a separate incision in your armpit for the lymph node biopsy. Occasionally a drain is required. Your incision will be closed with dissolvable sutures. A waterproof dressing will be placed.

What are the risks of wide local excision?

Bleeding. Infection. 20% chance of needing a further operation (to get adequate margins or take more lymph nodes). For those also having a sentinel node biopsy there are additional risks of lymphoedema 3 – 6%.  Injury to the intercostal brachial nerve causing numbness/tingling in the inner arm. Injury to long thoracic or thoracodorsal nerve (rare).  Allergy to blue dye 1/600.

Before the operation

Those with lesions that are unable to be felt will have wire placement with radiology on the day of surgery. You will be admitted on the day of surgery. You are not able to eat or drink for 6 hours before the procedure.

After the operation

You will likely stay one night on the ward, some people are able to go home the same day. Most people don’t require a drain.  If you do need one, this stays until there is less than 30ml/day coming out.  The District Nurse will monitor this and remove it. The dressing can stay on for 1 week and then be changed.  It is waterproof so you can shower with it and pat it dry. You will be seen in the rooms in 3 weeks once your results are available for a follow-up appointment. You may require other treatments for breast cancer including radiotherapy, chemotherapy and hormone therapy.  This will be known when you return to your follow up appointment and any referrals will be made to other specialties as needed.

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