Breast conserving surgery (lumpectomy)

What is breast conserving surgery?

The surgeon removes the area of cancer and some of the surrounding breast tissue. They leave behind as much normal breast tissue as possible.

Your surgeon may recommend this operation if the cancer is:

• small compared to your breast size

• in a suitable position in your breast

• only in one area of your breast

You usually have radiotherapy after this surgery. This is to destroy any cancer cells that may still be in the breast. This helps reduce the risk of the cancer coming back in the breast.

This type of surgery may not be suitable if you are unable to have radiotherapy afterwards.

The operation

During the operation, the surgeon removes the cancer and a border (margin) of normal breast tissue all around it. They might also remove some or all of the lymph nodes in your armpit (axilla). They send these to the laboratory.

A specialist doctor called a pathologist checks the border around the tumour for cancer cells. If there are no cancer cells, your report will say that there is a clear margin.

It is important to have clear margins with any surgery to remove cancer. It means that you are unlikely to need more surgery and the risk of cancer coming back in the future is lower.

You might need more surgery if the margin around the cancer contains cancer cells.

The scar

You will have a scar on your breast. You can’t usually see this when you wear a bra or swimming costume. You have another scar under your armpit if you have lymph nodes taken away. The scars will fade a bit over time.

Sometimes the surgeon can carry out the surgery using a cut (incision) around the dark area surrounding the nipple (areola). In time the scar becomes less visible.

How will your breast look?

Breast conserving surgery may not change the look of your breast too much. But in some women the breast might be smaller after surgery. The surgeon may need to operate on your other breast so that they look similar.

Your surgeon can tell you what to expect. They might be able to show you photos of what your breast is likely to look like afterwards.

Finding cancers that are too small to feel (occult lesion localisation)

Some early cancers are picked up through scans such as a mammogram, ultrasound scan, or MRI scan. These types of cancers may be too small for your surgeon to feel. They are called non palpable or occult lesions. Surgeons can use different ways to find the cancer so they can safely remove it.

They are split into two groups. One where you use a wire to find the cancer (wire guided localisation). The other group is called non wire guided localisation.

Your surgeon will tell you what type of technique they will use if its needed.

Wire guided localisation

You may have a wire guided localisation before your surgery. You may also hear this called a wire guided wide local excision. This means putting a thin wire into the breast tissue to show the surgeon the exact area to remove.

You have the wire put in while having an ultrasound or mammogram by the radiologist or breast surgeon. You usually have this done on the morning of your operation. You have a local anaesthetic, so you won't feel anything.

Once you are asleep for the operation your surgeon makes a small cut in your breast. The wire guides the surgeon to the right place. They then remove the cancerous breast tissue with a margin of healthy tissue. They take out the guide wire when they have finished.

Find out more about having a wire put in on the breast biopsy page

Non wire guided localisation

There are several different ways to find a breast cancer without using a wire. Your surgeon might use a type of marker that can show where the cancer is such as:

• a magnetic marker

• radioactive liquid or seed

• a electromagnetic wave reflector

• a radiofrequency tag

When you have it put in will depend on which type you have. Some markers are put in on the day or day before your surgery. Others you can have up to a few weeks before your surgery.

You have an ultrasound or mammogram to put the marker in the exact area that needs removing. You have a local anaesthetic, so you won’t feel anything.

During surgery, the surgeon uses a probe that can detect the marker and the breast tissue that needs removing.

Lumpectomy and reshaping the breast (therapeutic mammoplasty)

Some women may need a large amount of breast tissue removed. This will affect how the breast looks. In this situation your surgeon may recommend a therapeutic mammoplasty.

This means your surgeon will remove the cancer and use the remaining tissue and skin to create a new breast shape. This makes the breast smaller than before. You still have your nipple and areola.

You may also need surgery to your other breast so it looks symmetrical. You have this as a separate operation.

If you have small breasts your surgeon may need to use tissue from nearby to help reshape the breast. This is called a partial reconstruction. Your surgeon will talk to you in detail before the surgery about the procedure and what to expect.

Find out more about breast reconstruction

Removing lymph nodes

Sometimes breast cancer cells can spread into the lymph nodes in the armpit (axilla) close to the breast. It is important to know if there are cancer cells in the lymph nodes in the armpit and to find out how many of the lymph nodes contain cancer cells. This helps the doctors make decisions about your treatment.

Checking the lymph nodes before surgery

You have an ultrasound scan of the lymph nodes under your arm (axilla) at the same time as your other tests to diagnose breast cancer.

You usually have a ​biopsy​ of any lymph nodes that look abnormal. The biopsy is sent to the laboratory to check for cancer cells.

If this shows that the cancer has spread to the nodes in the armpit, you will have surgery to remove all or most of them. You have this at the same time as your breast surgery. This is called an axillary lymph node dissection (ALND) or clearance.

If the lymph nodes look normal during the ultrasound scan, you don’t have a biopsy. But you will have a sentinel lymph node biopsy (SLNB) during your surgery.

Checking lymph nodes during surgery (sentinel lymph node biopsy)

Lymph nodes that look normal on ultrasound are checked by your surgeon during your operation to remove the breast cancer. This is called a sentinel lymph node biopsy (SLNB). 

The sentinel node is the first lymph node in the armpit where the fluid from the breast drains into. This means it’s the first lymph node the cancer could spread to.

Checking with a radiotracer and blue dye

A few hours before the operation, your doctor or a radiographer injects a small amount of mildly radioactive liquid into your breast close to the cancer. The radioactive liquid is called a tracer.

During the operation, your surgeon might also inject a small amount of blue dye into the breast. The dye and the tracer drain away from the breast tissue into nearby lymph nodes.

The surgeon can see which group of lymph nodes the blue dye reaches first. They also use a radioactive monitor to find out which nodes the tracer gets to first. 

The dye can stain your breast slightly blue. It gradually fades over a few weeks or months. The dye may also turn your urine green for a few days.

Checking using the Magtrace and Sentimag system

In some hospitals surgeons use the Magtrace and Sentimag system to find sentinel lymph nodes. Magtrace is a magnetic liquid tracer that is dark brown in colour. This is injected into the breast tissue around the cancer. It acts as a magnetic marker and dye. The lymphatic system in the area soaks up the injected liquid and it gets trapped in the sentinel lymph nodes. You can have Magtrace up to 30 days before your operation. During your operation the surgeon uses a probe called a Sentimag to detect the magnetic liquid trapped in the sentinel lymph nodes. The liquid also acts like a dye so the surgeon can see where it is trapped. The surgeon can then remove the sentinel lymph nodes for testing.

Removing the nodes

The surgeon usually removes about 1 to 3 of these nodes. They might remove other lymph nodes if they look as though they might contain cancer cells. They send the nodes to the laboratory to check for cancer cells. The results can take a few weeks. If the lymph nodes do not contain cancer cells, you won’t need to have any more nodes taken out. If there are cancer cells in the sentinel nodes you usually need more treatment. You may have another operation to remove most or all of the lymph nodes under your arm. This is called axillary lymph node dissection or clearance. This is generally about 2 weeks after you get the results. Some people have radiotherapy to the armpit to destroy any remaining cancer cells instead of surgery.

Getting the results during the operation

In some hospitals, the surgeon gets the results of the sentinel lymph node biopsy during the operation. They can then remove the rest of the nodes if necessary and you avoid having a second operation.

Your surgeon will talk to you about this before your operation if this is the plan for you.

Find out what happens after surgery

Research into lymph node surgery

Possible problems after breast conserving surgery

There is a risk of problems or complications after any operation. Treating them as soon as possible is important. Some of the problems include:

• bleeding from the wound

• infection 

• fluid collecting around the operation site (seroma) 

• blood collecting around the operation site (haematoma)

• nerve pain

• numbness

• shoulder stiffness

• swollen arm or hand

• scar tissue in the armpit (cording) if you have had lymph nodes removed

• ​blood clots​

Find out more about some of these problems after surgery

Follow up after surgery

You have follow up appointments to check your recovery and sort out any problems. They are also your opportunity to raise any concerns you have.

You usually see your surgeon one to two weeks after your operation. They examine you and check your wound is healing well.

Your surgeon will explain the results of your surgery and talk about any further treatment you might need.

You'll have contact details for your breast care nurse or the ward if you need to contact someone before your follow up appointment.

Read more about follow up after treatment

Radiotherapy after surgery

You usually have radiotherapy to the whole breast after having breast conserving surgery. Your doctor will tell you how soon you will start this. If you are having chemotherapy after your surgery, you usually have the radiotherapy after chemotherapy.

Certain hospitals may offer radiotherapy to part of the breast during surgery. This is called intra-operative radiotherapy. Or you may not have radiotherapy at all if you have a very low risk of the cancer coming back. 

Some people who have a higher risk of cancer coming back may have extra radiotherapy. This is called a radiotherapy boost. A boost is extra doses of radiotherapy targeted at the area in the breast where the cancer was removed.

Your cancer specialist will explain in detail the benefits and risks of radiotherapy and what is best for your situation.

Find out more about radiotherapy for breast cancer

Davina's breast cancer story

Davina had a lumpectomy and lymph nodes removed. 

“I’m getting stronger every day by doing the exercises I was shown at the hospital.”

Read Davina's story about her treatment and how she coped