In some instances, you may be offered an excision biopsy, where the whole lump is removed under general anaesthetic. This is obviously a more radical operation, carrying all the risks of anaesthesia and should be avoided unless absolutely necessary. If you are offered excision, ask why you cannot have one of the less radical approaches. Seek a second opinion if you're not happy with the explanation.
If you do agree to an excision biopsy, read the operation consent form you are asked to sign carefully. Make sure you are agreeing only to the biopsy and nothing more drastic. Last year, the Department of Health issued guidelines to hospitals urging them to use narrow consent forms, which give the surgeon permission only to remove the lump not the entire breast if he sees fit. However, some hospitals may still be relying on the old style forms and if yours is one of them, cross out the bits you don't wish to agree to and tell your surgeon what you've done. Even if he is cavalier about lopping off your breast, he is unlikely to be quite so sanguine about leaving himself open to a clear cut malpractice suit by going against your express wishes.
Don't be bullied or panicked. If your surgeon won't treat you on this basis, go somewhere else. Operations for breast cancer are almost never emergency operations so you should be allowed time to consider your treatment options if cancer is diagnosed or suspected. As the following chilling case study shows, supplied by Aspect, the Jeannie Campbell Breast Cancer Radiotherapy Appeal, it may be essential to get a second opinion. If you sign a wide ranging consent form you may never get the opportunity to do so before it's too late.
"I went into hospital for a biopsy. I came to in dreadful pain, unable to move my left arm. I asked what had happened and soon had the ward nurse telling me there was nothing wrong with me. I crawled to the toilets and removed just enough dressings to realise my left breast was missing and something frightful had happened to my arm, which is crippled to this day.
"Somehow I got back to my bed and started to cry. No one came to my help until two doctors stood over me. The senior one said I had cancer so badly, I had six months to live.
"I put my husband in the hands of my daughter and flew out to Australia to die with my son. I gave away all my personal effects. In Australia, it was my son who pushed me into a clinic where I was vetted from top to toe.
"I did not have breast cancer. I have never had cancer. I am not going to die of cancer. I was just a wrong diagnosis.
I came home and picked up the pieces of my life."
Fiona Bawdon is a WDDTY contributing editor. Next month, we'll report on breast cancer treatments.