What is a wide local excision?

A wide local excision involves removing the cancer with a rim of breast tissue around the cancer. 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. These treatments on their own are unlikely to lead to you being cured and they also have side effects and complications. However, they may shrink the cancer or control the cancer for a few years.

What will happen if I decide not to have the procedure?

If appropriate, your surgeon will discuss non-surgical treatments with you.

The cancer may not be controlled by other treatments, or the cancer may be controlled at first and then spread in a few months or years.

What does the procedure involve?

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 wide local excision or a mastectomy.

What complications can happen?

The breast-care team are trained try to reduce the risk of complications.

Any risk rates given are taken from studies of people who have had this procedure. Your doctor may be able to tell you if the risk of a complication is higher or lower for you. Some risks are higher if you are older, obese, have other health problems or you smoke. Health problems include diabetes, heart disease or lung disease.

General complications of any procedure

• Bleeding during or after the procedure. You may need a blood transfusion or another procedure and it is common for your chest or armpit to be bruised.
• Infection of the surgical wound.
• Allergic reaction to the equipment, materials or medication.
• Venous thromboembolism (VTE). This is a blood clot in your leg (deep-vein thrombosis – DVT) or one that has moved to your lung (pulmonary embolus).
• Chest infection. Your risk will be lower if you have stopped smoking and you are free of COVID-19. (coronavirus) symptoms for at least 7 weeks before the procedure.

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. You may need another procedure to remove the blood.
• Developing a hard lump in a breast caused by scarring or damaged fat tissue. You may need a scan or biopsy to assess a lump in the future.
• Dissatisfaction with breast appearance over time. Infection and bleeding can also affect the appearance of your breast.
• Stiff shoulder. Treatment for a frozen shoulder may involve physiotherapy, medication and injections.
• Numbness or continued pain around your armpit or the inner part of your arm. Numbness can last for up to 6 months and can sometimes be permanent.
• Arm weakness or swelling of your arm and hand (lymphoedema). You can get lymphoedema months or even years later. It will make your arm prone to infection.
• Surgery to redo the excision (re-excision). If there are cancer cells near the edge of the tissue that was removed, you may need further surgery.

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 with you any treatment or follow-up care you need. They will also check your wound and be able to tell you when you can return to work.

Summary

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, which helps your surgeon to decide on any further treatment.

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