Breast Surgery

A wide local excision (sometimes referred to as a lumpectomy) is an operation to remove either a cancer or a pre-cancerous area (surrounded by a margin of healthy tissue) from the breast. 

Usually, the operation also includes taking away some of the lymph glands from the armpit (axilla).

A mastectomy is an operation that involves removing all the breasts, including the nipple.  It usually includes the removal of some of the lymph glands from the armpit (axilla). 

The mastectomy leaves a horizontal scar across your chest - from under your arm, to just before your breastbone. 

Lymph nodes from the armpit (axilla) are commonly removed in treating breast cancer. 

The main reasons to do this are:  

• The presence or absence of cancer cells in lymph nodes is used to determine any additional treatment which may be necessary for breast cancer, such as drug therapy or radiotherapy.
• If cancer cells are present within the lymph nodes, they can grow there and cause problems in the armpit, such as pain, obstruction of blood vessels and swelling of the arm (lymphoedema) on the affected side. Removal of affected nodes can help to prevent this. 

Breast reconstruction is the creation of a new breast shape using surgery. It may be done after the removal of a whole breast (mastectomy) or part of the breast (breast-conserving surgery).

You can have reconstruction at the same time as breast cancer surgery (immediate reconstruction), or months or even years later (delayed reconstruction). Breast reconstruction often involves several operations to give you the best outcome possible.

There are usually different options available for breast reconstruction and your breast surgeon will explain which one is most suitable for you.

The new breast shape can be created using an implant and/or your own tissue from another part of the body, usually the back or lower abdomen (belly). Reconstructed breasts don’t usually have a nipple but one can be created with surgery and tattooing at a later date. Prosthetic stick-on nipples can also be used.

Breast reconstruction aims to create a breast shape that looks as natural as possible and to try to match the breast on the other side in size, shape and position. However, even with the best outcome, there will be differences between the remaining breast and the reconstructed one, and sometimes surgery on the other side can help. This can be done at the same time as the reconstruction, but waiting for the reconstruction to heal and settle into position may be better. Your specialist team will give you an idea of how long this is likely to be.

There are usually different options available for breast reconstruction and your breast surgeon and breast care nurse will explain which one is likely to suit you best. It’s helpful if you can take some time to consider these options without feeling under pressure to make a decision. You may need a couple of discussions with your specialist team before you feel confident deciding what to do.

For more information, see Breast Cancer Now's leaflet about Breast Reconstruction. 

Lipomodelling is also known as fat transfer or fat grafting. It is used to improve the contour/shape where there is an indentation in reconstructed breasts or at the site of a previous wide local excision (lumpectomy). It can also be used to increase the size of a reconstructed breast. Often two or three procedures spaced out over several months are needed.

How is it done?

Fat is taken from your own body, often from the abdomen (tummy), thighs or buttocks in a procedure called liposuction. This is similar to cosmetic fat reduction but we only take the fat we need so you will not notice much of a difference. The fat that is removed is washed and concentrated. It is then grafted (re-injected) with great care in small amounts in the area we are treating. The procedure is done under a general anaesthetic, usually as a day case.

See our Lipomodelling Patient Information Leaflet for more information.