What is an imaging-assisted wide local excision?

An imaging-assisted wide local excision (lumpectomy) involves removing the cancer with a rim of breast tissue around the cancer.

Before the procedure, if your surgeon cannot feel the cancer, they will plan for a breast radiologist to carry out a marking procedure.

Your surgeon will tell you if your nipple needs to be removed. As well as removing your breast tissue, your surgeon may remove glands (lymph nodes) in your armpit to find out if there are any cancer cells in them.

What are the benefits?

Removing the cancer by surgery gives you the best chance of being free of early breast cancer. The breast tissue and lymph nodes that your surgeon removes will be examined under a microscope to help decide on any further treatment.

Are there any alternatives?

You may want to consider a mastectomy (removing all your breast).

If you have invasive breast cancer, where the cancer has grown through the ducts to the surrounding breast tissue, there are other treatments available such as hormone therapy, chemotherapy, radiotherapy and biological therapy.

What does the procedure involve?

A breast radiologist will mark your breast before the procedure.

• Pen marking — This procedure is suitable if the cancer is close to your skin.
• Wire marking — This involves inserting a flexible wire (guidewire) through a needle to mark where the cancer is.
• Magnetic or radioactive seeds, or carbon nanoparticles — Your doctor will use a needle and mammogram machine or ultrasound scanner to place metal or carbon particles near the cancer.

The procedure is usually performed under a general anaesthetic but various anaesthetic techniques are possible. The procedure usually takes about an hour.

Your surgeon will make a cut on your breast. They will remove the cancer with a rim of breast tissue around the cancer.

Your surgeon will usually remove any lymph nodes from your armpit through the same cut or through another cut closer to your armpit.

All your breast tissue and lymph nodes removed will be examined under a microscope. If there are cancer cells near the edge of the tissue that was removed, your surgeon may recommend another excision or a mastectomy.

What complications can happen?

Possible complications of this procedure are shown below. Some may be serious and can even be life threatening.

General complications of any procedure

• bleeding
• infection of the surgical site (wound)
• allergic reaction to the equipment, materials or medication
• venous thromboembolism (VTE)
• chest infection

Specific complications of this procedure

• developing a lump under your wound caused by fluid collecting
• developing a lump under your wound caused by blood collecting
• developing a hard lump in a breast caused by scarring or damaged fat tissue
• numbness or continued pain around your armpit or the inner part of your arm
• stiff shoulder
• arm weakness or swelling of your arm and hand
• failure to remove the cancer
• dissatisfaction with breast appearance over time
• surgery to redo the excision

Consequences of this procedure

• pain
• scarring of your skin, which may be unsightly

What happens after the procedure?

You are expected to go home the same day.

You should be able to build up to normal activities after 2 to 3 weeks.

Regular exercise should help you to return to normal activities as soon as possible. Before you start exercising, ask the breast-care team or your GP for advice.

The breast tissue and lymph nodes that your surgeon removed will have been examined under a microscope. Your surgeon will tell you the results and discuss any treatment or follow-up care you may need.

Summary

Surgery gives the best chance of you being free of early breast cancer. If your surgeon cannot feel the cancer, they can use radiology procedures to help find out where the cancer is. A wide local excision involves removing the cancer with a rim of breast tissue around the cancer. It usually involves removing some of the lymph nodes in your armpit.

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