Breast

Wide Local Excision (Lumpectomy) with Sentinel Node Biopsy

WIDE LOCAL EXCISION (LUMPECTOMY) WITH SENTINEL NODE BIOPSY

Indication: Early invasive breast carcinoma (DCIS or invasive carcinoma suitable for breast-conserving surgery — tumour typically <4 cm, single lesion, adequate breast-to-tumour ratio). Sentinel node biopsy for staging in clinically node-negative axilla.

Patient Position: Supine, arm extended on arm board. Ipsilateral shoulder elevated with a sandbag.

Anaesthesia: General.

Prophylactic Antibiotics: Per local protocol.

Pre-operative: Wire-guided localisation or radioactive seed localisation of impalpable lesions. Periareolar or peri-tumoural injection of radiocolloid (and/or blue dye) for sentinel node mapping — typically performed 2–4 hours before surgery.

Procedure — Wide Local Excision:
1. Skin incision placed over the tumour, within Langer's lines (transverse for upper breast, radial for lower pole). If impalpable, wire or seed guides the incision.
2. Skin flaps raised. Breast tissue excised around the tumour with a circumferential margin of macroscopically normal tissue (aim for minimum 1 mm clear margin for invasive carcinoma).