Wide Local Excision & Lumpectomy with Flap Reconstruction
These oncoplastic techniques integrate cancer removal and aesthetic repair in one step, maintaining breast shape while ensuring complete tumour excision.
What Is Wide Local Excision & Lumpectomy with Flap Reconstruction?
Wide local excision, also known as lumpectomy or breast-conserving surgery, involves removing a tumour with a rim of healthy tissue to ensure clean margins. When a large volume of tissue is removed, the breast can become visibly deformed. In such cases, reconstructive surgery using local perforator flaps (LICAP, LTAP, AICAP, MICAP, Angel Flap) reposition chest-wall tissue at the edge of the breast to fill the defect immediately during the same operation.
These oncoplastic techniques integrate cancer removal and aesthetic repair in one step, maintaining breast shape while ensuring complete tumour excision.
Who Is a Candidate?
Ideal candidates are:
- Women with early-stage breast cancer (DCIS, Stage I or II; occasionally Stage III if large breasts and no spread)
- Patients with small or medium breasts where therapeutic mammoplasty is not possible
- Patients who are fit for postoperative radiotherapy (unless contraindicated, e.g. connective tissue disease, prior breast irradiation, pregnancy)
- Patients for whom preserving the breast is a priority, but where simple lumpectomy would cause a noticeable deformity
Types of Flap & Procedure Steps
Surgical Options
- Volume displacement / Level 1 oncoplastic techniques: reposition remaining breast tissue under skin to fill the defect.
- Volume replacement / Level 2 techniques: use a local perforator flap (LICAP, LTAP, MICAP, AICAP, Angel Flap). Tissue (skin + fat) near the tumour site is rotated into the defect, preserving blood vessels without sacrificing muscle.
Procedure Overview
- Tumour removal (wide local excision) with margin assessment
- Sentinel‑node biopsy or axillary sampling through the same incision if possible
- Raising the local perforator flap (often via lateral or intercostal vessels)
- Rotating and securing tissue to fill the excision defect
- Closure and symmetry adjustments; potential contra‑lateral breast surgery may rarely be required later for balance
Benefits of Breast Implant Removal
- Relief from discomfort, pain, or tightness
- Peace of mind if concerned about implant-related complications
- A return to a more natural breast shape and feel
- Improved body confidence and lifestyle compatibility
- Freedom from long-term implant maintenance or replacements
Patient journey
Stage | What Happens |
Pre‑op | Imaging, tumour localisation (wire or seed), medical assessment, surgical planning. Fasting instructions and discussion with breast care team |
Day of surgery | Under general anaesthetic, tumour removed and flap reconstruction performed in same session – procedure usually 2 hours depending on complexity |
Hospital stay | Typically same day discharge or overnight stay; pain managed via analgesia |
Weeks 1–2 | Dressings in place; drains are not typically used; some mild swelling and bruising |
Weeks 3–6 | Gradual return to light activity; scar and flap settle; full recovery often at 6 weeks |
Later | Radiotherapy usually begins 6-8 weeks post-op; symmetry surgery (lift or reduction on the other breast) may follow after cancer treatment ends (often ~1 year later) |
Frequently Asked Questions (FAQ)
It preserves most of the breast while ensuring oncologically safe margins. If a flap prevents deformity, a mastectomy may be avoided with equivalent long-term survival for early-stage cancers.
Local perforator flaps involve skin and fat, but not muscle, so arm and chest wall function are preserved. You’ll have incisions at the edge of the breast/donor site but these fade and are hidden in natural folds.
Most patients are discharged the day of surgery or stay in hospital overnight; full recovery is typically six weeks; radiotherapy afterwards may prolong the overall journey.
As with any surgery: infection, bleeding, flap loss, delayed healing. Radiotherapy may affect cosmetic outcome long‑term.
Re‑excision may be needed. If a clear margin cannot be achieved, a mastectomy may be recommended.
Yes. To achieve balance, a breast reduction, lift, or fat transfer may be offered simultaneously or after recovery, often after the effects of radiotherapy are known.
Book Your Private Consultation
If you’re considering a Wide Local Excision & Lumpectomy in Newcastle or Gateshead, book a consultation with Mr Milligan to explore your options and receive a personalised treatment plan.
