Wide Local Excision
Wide local excision (WLE), also called breast conservation surgery or lumpectomy, is an operation to remove a breast cancer with a margin of healthy tissue.
The position of the incision (and therefore the scar) depends on the size and shape of your breasts and the position and size of the cancer. Every effort it made to minimise any scarring to the breast.
Sometimes a localisation wire is needed to help the surgeon remove the breast cancer, often because it is difficult to feel.
Key points
- Operation to remove breast cancer
- Usually day surgery
- May need localisation
- Likely to need radiotherapy
- Low (but not zero) risk
Alternatives
Anyone with breast cancer can choose to have a mastectomy (removal of the whole breast). Anyone can choose to “go flat” and most women are suitable for some type of breast reconstruction.
Wide local excision can be combined with a breast reduction (also called therapeutic mammoplasty). This can allow the safe removal of tumours which might otherwise need a mastectomy.
Potential problems
- Bleeding, including a pocket of blood under the skin (haematoma) (5%)
- Wound infection (<5%)
- Change to the shape of your breast
- Need for a second surgery (usually to ensure all cancer cells are removed) (15%)
- Breast cancer recurrence (1% per year)
- Risk of anaesthesia (low)
Associated treatment
If your breast lump is hard to feel, you may need a localisation wire to help ensure the right area is removed. This is a bit like having your biopsy and is usually performed on the morning of surgery using local anaesthetic.
Most women having WLE will also need surgery to check the lymph glands in the armpit. Nearly all will be advised to have radiotherapy. This reduces the risk of any breast cancer recurring in the breast. Choosing a mastectomy can avoid the need for radiotherapy.
Many women with breast cancer are recommended to take hormonal therapy for several years. This depends on the biology of your cancer and will be discussed with you in detail if needed.
Some women are recommended to have chemotherapy or targeted therapy for several months. Again, this depends on the biology of your tumour and you will discuss this in detail with your medical oncologist if needed.
On the day of surgery
You will need to fast for 6 hours before surgery. You can take any medications as normal and continue to drink water until 2 hours before surgery.
You should shower and wash well in the morning. Bring something to do as there will be a lot of waiting.
When you arrive you will be checked in by the nurses and change into a gown and stockings ready for the operation.
In the holding bay
You will see your surgeon and anaesthetist, have a drip put in and have the operative site marked. You might also be given premedication.
In recovery
After surgery you will go to recovery. You will be watched closely until you are alert and well enough to return to the ward. You might be given medication for any sickness or pain.
After surgery
Swelling or bruising is common and usually settles on its own.
Your dressings will be splash resistant but try not to soak them. Pat them dry after a shower. You can remove them if they start to peel off but if they remain neat and tidy keep them on for 5 days.
Pain and discomfort can usually be managed with simple painkiller tablets.
Eat healthily and try to exercise a little every day. You might find your movement restricted for a while. The exercises given to you by your breast care nurse will help to minimise stiffness.
If you have any concerns call the team - we would rather know about it and you are never wasting our time! We can always arrange for you to come to the clinic if needed and if you are unwell out of hours you can always attend the emergency department.
Driving
You need to be able to concentrate properly and perform an emergency stop without any distracting pain. You will probably need to avoid driving for 1-2 weeks, but check with your insurance company.
Work
Getting back to work can be necessary or helpful for many women, but you will probably need to wait at least until you get your results and can plan any further surgery or treatment.
EDI: mybreast
