Surgery Breast Procedures

Breast Conservation Surgery

Also referred to as a Lumpectomy. A total mastectomy is no longer always needed for breast cancer treatment. All patients with benign diseases, and most women with breast cancer, can be treated safely with breast conservation surgery. A range of surgical approaches is used to maximise the cosmetic result after breast-conserving procedures. 

Radiotherapy is usually used to reduce the risk of recurrence in the remaining breast tissue after breast-conserving surgery. Occasionally a second surgical procedure is necessary if breast conservation is not successful in removing all affected breast tissue.

Axillary Clearance

Surgically removing all of the lymph nodes situated in the axilla (armpit) is a necessary part of breast cancer surgery if the breast cancer cells have spread to these nodes. Axillary clearance is usually performed if the sentinel node has been found to contain cancer. 

On average, 20 - 30 nodes are removed, but this does not harm the immune system. Some (approximately 15%) patients develop arm swelling, which is well managed by lymphatic drainage massage and a compression sleeve.

Hook-wire Localisation

Early breast disease is often detected on mammograms or ultrasounds before a lump can be felt in the breast. 

Surgical excision of that part of the breast may be needed to obtain tissue for examination by the pathologist, pr for definitive treatment. 

As the lesion in the breast is not palpable, a fine hook wire is inserted into the lesion on the day of surgery using a mammogram or ultrasound to guide the accurate placement of the wire. 

The surgeon can then use the guidewire during the operation to remove only the abnormal breast tissue and preserve normal tissue. 

This complex procedure improves the accuracy of excising the abnormality and breast cosmesis by preserving normal tissue.

Microdochectomy

A microdiscectomy is a targeted surgical procedure whereby a single duct behind the nipple is removed for examination by the breast pathologist. 

It is performed if there is a suspicious discharge from a single duct in the nipple. 

The specific duct is identified under general anaesthetic and is isolated with a fine probe so that it can be removed without damaging the remaining ducts. 

It is most suitable for younger women who wish to preserve the ability to breastfeed after surgery. A small incision around the areola is used to minimise scarring after surgery.

Subareolar Duct Excision

The major breast ducts coalesce behind the nipple/areola complex. 

Suspicious discharge for the nipple may be the first indication of significant disease in the ducts, even in the absence of clinical or imaging findings. 

Subareolar duct excision removes all of the major ducts from behind the nipple to stop the discharge and to provide the pathologist with the duct tissue for examination. 

The nipple is preserved, but breastfeeding is impossible after a sub-areola duct excision. Usually, the cause of the discharge is benign duct disease requiring no further treatment, but if breast cancer is found in the ducts, further surgery may be required.

Open Biopsy

Open surgical biopsy under anaesthetic has largely been replaced by fine needle and core biopsies (see above). There remains, however, the unusual situation where a lesion in the breast is atypical and needs to be fully removed for complete examination by the pathologist. 

Occasionally a patient may prefer to have a benign lesion removed rather than continue surveillance. 



Cosmetic skin crease incisions are used to reduce the risk of scarring. Buried dissolving sutures and waterproof dressings are used so that the patients can return to normal activities as soon as possible.