Wide Excision, also known as lumpectomy, is a key component of breast conservation surgery. Unlike mastectomy, which involves complete removal of the breast tissue, wide excision targets only the tumor and a margin of the surrounding tissue. The extent of tissue removal may vary depending on factors such as tumor size, location and pathology.

Who Needs Wide Excision?

Wide excision is typically recommended for patients diagnosed with breast tumors, particularly those with small tumors confined to the breast tissue. It may also be considered for patients with larger tumors who desire breast conservation over mastectomy, provided that the tumor is amenable to removal with clear margins.

Procedure of Wide Excision:

• Preoperative Evaluation: Before undergoing wide excision, patients typically undergo a series of preoperative evaluations, including physical examination, imaging studies such as mammography or ultrasound, and sometimes, biopsy to confirm the type of tumor.

• Anesthesia: The procedure is performed under general anesthesia to ensure the patient's comfort and safety throughout the surgery.

• Incision: The surgeon makes an incision over the breast to access the tumor. The size and location of the incision may vary depending on the size and location of the tumor.

• Tumor Removal: Using precise surgical techniques, the surgeon carefully removes the tumor along with a margin of the surrounding healthy tissue. The goal is to achieve clear margins, ensuring that no tumor cells are left behind.

• Sentinel Lymph Node Biopsy (Optional): In some cases, sentinel lymph node biopsy may be performed during wide excision to determine if the cancer has spread to the nearby lymph nodes.

• Closure: Once the tumor has been removed, the surgeon closes the incision with sutures or surgical staples. Depending on the extent of the surgery, drainage tubes may be placed to prevent fluid buildup.

Advantages of Wide Excision:

• Preservation of Breast: One of the primary advantages of wide excision is the preservation of the breast. By removing only the tumor and a surrounding margin of tissue, this approach maintains the breast's cosmetic appearance and preserves its natural shape, which can have significant psychological benefits for patients.

• Reduced Morbidity: Compared to mastectomy, wide excision typically involves less extensive surgery and is associated with lower morbidity rates. Patients undergoing breast conservation surgery often experience shorter recovery times, less postoperative pain, and fewer complications, allowing for quicker return to normal activities.

• Equivalent Oncologic Outcomes: Numerous studies have demonstrated that breast conservation surgery with wide excision offers equivalent oncologic outcomes compared to mastectomy for appropriately selected patients. When combined with adjuvant therapies such as radiation and chemotherapy, wide excision has been shown to achieve excellent long-term survival rates.

Wide excision is a vital component of breast conservation surgery, offering a less invasive alternative to mastectomy. By preserving much of the breast tissue while effectively removing the tumor, wide excision allows patients to achieve excellent oncologic outcomes while maintaining the appearance and sensation of their breasts.