How to perform adequate local excision of mammographically detected lesions

With an increasing proportion of nonpalpable breast cancers being discovered by mammography, the opportunities for breast conservation are increasing commensurately. It is important to have a practical surgical approach for local excision to preserve cosmetic appearance and simplify management. Skin incisions should be circular and central for the bulk of local excisions and lumpectomies of both invasive and noninvasive breast cancers to allow both the greatest flexibility for later mastectomy if it is required and the best cosmetic appearance. Suggestions are based on two decades of clinical practice and careful evaluation of consultant patients encountered and patients operated upon and managed. Adherence to Langer's lines of skin orientation and meticulous attention to surgical detail, with better cosmetic appearance, will pay large dividends in patient satisfaction. Guidelines for use of local anesthesia, handling of the residual cavity after local excision, management of the surgical specimen, and wound closures are elaborated.