Wide local excision breast

Follow radial Langers lines and transverse Kraissl lines for incision.
Incise cancer directly over lesion
There is no need to excise skin unless cancer close to skin or skin is tethered.
Cosmetic result is influenced by amount of skin excised.
Limiting the length of incision will improve cosmetic result
Then dissect skin and subcutaneous tissue off breast, avoiding thin skin flaps.
Once elevated skin flaps 1-2cm beyond cancer, put left hand over cancer and divide breast 1cm beyond cancer.
In majority of patients go down to pectoral fascia
Then grap cancer and complete margins and orientate specimen for pathologists
Ligaclip cavity for XRT
Close defect by mobilising surrounding breast tissue from both skin and pectoralis (if not then they will fill with seroma which will then form contracted ugly scar tissue) with interrupted vicryl
Do not use a drain as it increases infection
Layered closure with vicryl/monocryl