Breast-Preserving surgery
Wide local excision (Lumpectomy), Hook-Wire localisation, and Oncoplastic techniques
By Graeme Millar, Lead Breast Surgeon – Otago Surgical Associates
Many people diagnosed with breast cancer or pre-cancer can be treated with breast-preserving surgery. This approach aims to remove the cancer completely while conserving as much normal breast tissue as possible, and, where appropriate, optimising cosmetic appearance. My role is to guide you through these options, explain what to expect, and tailor treatment to you whilst delivered locally here in Dunedin and Otago.
What is breast-preserving surgery?
Breast-preserving surgery, also known as wide local excision or lumpectomy, involves removing the cancer with a surrounding rim of normal tissue (a “clear margin”), while keeping the rest of the breast intact. For many patients, this provides excellent cancer control when combined with other treatments such as radiotherapy.
This approach is suitable for many early breast cancers and for conditions such as DCIS, depending on size, location, and imaging findings.
When is breast-preserving surgery appropriate?
Whether breast-preserving surgery is recommended depends on:
The size and location of the cancer
The size of your breast
Whether the disease is confined to one area
Imaging results (including MRI when needed)
Your personal preferences
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On the morning of surgery, under Local anaesthetic a radiologist places a thin wire(s) into the breast under mammogram or ultrasound guidance
The wire marks the exact location of the area to be removed
During surgery, I use this wire to accurately remove the targeted tissue
Hook-wire localisation improves precision and helps ensure the correct area is removed while preserving healthy tissue.
Other techniques such as “Magseed” (magnetic localisation) and SCOUT localisation are currently under review in Dunedin Otago
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Oncoplastic surgery combines cancer surgery with plastic surgical techniques to improve breast shape after tumour removal.
This may involve:
Reshaping the remaining breast tissue
Redistributing tissue to fill the space where the cancer was removed
Adjusting incision placement to minimise visible scarring
The goal is to maximise cosmetic outcome without compromising cancer treatment.
Not every patient requires oncoplastic techniques, but when used appropriately they can:
Reduce contour defects
Improve breast symmetry
Minimise long-term cosmetic changes
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The tissue removed during surgery is carefully analysed by a pathologist. This confirms:
The exact diagnosis
Whether margins are clear
Whether further treatment is needed
If breast-preserving surgery is performed, radiotherapy is commonly recommended to reduce the risk of recurrence in the breast. Additional treatments (such as hormone therapy or chemotherapy) are guided by tumour biology and discussed with you often by the wider team.
Our approach at Otago Surgical Associates
At OSA, breast-preserving surgery is:
Cancer-focused – complete removal with clear margins
Individualised – tailored to your anatomy and diagnosis
Oncoplastic-aware – using reshaping techniques when helpful
Local – delivered here in Dunedin and Otago
Multidisciplinary – supported by a full breast cancer team
Reassurance
For many patients, breast-preserving surgery offers excellent cancer outcomes with the benefit of conserving the breast. When combined with careful planning and oncoplastic techniques, it can achieve both effective cancer treatment and good cosmetic results.
If breast-preserving surgery has been recommended for you, my commitment is to guide you through the process with clarity, care, and local expertise—supporting you from assessment through surgery and into recovery and follow-up.