If your breast team has mentioned an operation to something in your chest — a spot on the breastbone or a rib, a lymph node behind the ribs, a shadow on the lung, or fluid around it — this page explains what is being considered and why. Most people whose breast cancer has spread do not have surgery of this kind; whole-body treatment is the mainstay. For a small, carefully selected group it forms part of the plan, and the decision belongs to the multidisciplinary team caring for your breast cancer. Patients reach Dr Lawrence Okiror, Consultant Thoracic and Robotic Surgeon (GMC 6150382), because that team has referred them. He carries out one step; your breast team continues to lead your care. London Bridge Hospital and The Lister Hospital Chelsea, within 2–3 working days.
Last reviewed: August 2026 · Dr Lawrence Okiror FRCS(CTh) FRCSEd(CTh) · GMC 6150382
Breast cancer that has spread is treated principally with whole-body therapy. Surgery to a single deposit is for a small selected group, and it does not replace that treatment.
The team that knows your cancer, your treatment and how it has behaved over time makes the decision. A thoracic surgeon is asked to carry out one step, not to take over your care.
Sometimes the operation is to find out what a lesion is. Sometimes it makes another treatment possible. Sometimes it is to remove a single site of disease. These are not the same thing.
Because a scan has shown something inside the chest that your team wants either removed or sampled, and the chest is not their operating territory. The referral means your case has already been discussed and the team has concluded that a thoracic surgical opinion is worth having. It does not mean a decision has been made, and it does not mean the news is worse than you have been told.
It is worth being clear about the direction of travel, because it is the opposite of what many people assume. Patients are not recruited to this operation. They arrive because a breast multidisciplinary team — oncologists, radiologists, breast surgeons and specialist nurses — has looked at the whole picture and raised local treatment as an option. The thoracic surgeon assesses whether the operation is technically sound and safe, explains it, carries it out where it is agreed, and sends you back. Your breast team leads your treatment throughout.
People arrive at the same clinic for genuinely different reasons, and the reason matters — it determines what the operation is expected to achieve. Broadly, there are four.
A scan can show that something is there. It often cannot say what it is. In someone previously treated for breast cancer, a new spot may be breast cancer that has spread, an entirely separate new cancer, or something benign — and the treatments differ completely. Where the answer changes the plan, obtaining tissue is the point of the operation.
Sometimes the treatment being planned — targeted radiotherapy, for example — requires the diagnosis to be confirmed first, and the lesion sits somewhere a needle cannot safely reach. Here the operation is not the treatment. It is what unlocks it.
Where careful scanning shows disease at one site only, and the cancer has responded well to systemic treatment, some breast teams consider treating that single site directly — by surgery, or by targeted radiotherapy. This is a considered judgement made case by case, and it is made by the breast multidisciplinary team.
Chemotherapy or other systemic treatment sometimes shrinks disease substantially but leaves a small amount behind at one site. Where everything else has cleared and that residual deposit is the only remaining problem, removing it may be considered.
Yes, in selected patients — and this surprises people, because a deposit in bone sounds like something that must be beyond surgery. The breastbone and the ribs are part of the chest wall, and the chest wall is thoracic surgical territory.
The principle of the operation is complete removal. That means taking the affected part of the breastbone or rib together with a margin of normal bone around it, rather than scraping the cancer away and leaving the bone in place. Removing a margin of healthy bone is not caution for its own sake — it is how the surgeon can be confident nothing has been left behind, and it is the part of the operation that determines whether it has done its job.
What happens to the gap. Removing part of the chest wall leaves a defect, and where one is left it is covered using the material appropriate to its size and position. Not every defect needs covering — a small one in a well-supported position may need nothing at all, while a larger one, or one at the front or side of the chest, needs proper reconstruction to keep the chest wall stable.
The aim is a chest wall that is stable, protected, and comfortable, with nothing visible or able to be felt through the skin afterwards. The reconstruction is permanent and needs no maintenance. More on chest wall resection and reconstruction →
Whether this is the right thing to do in any individual case is a decision for the breast multidisciplinary team, weighed against targeted radiotherapy and against continuing systemic treatment alone. Surgery is not automatically the better answer because it is available.
Most biopsies are taken with a needle, guided by a scan. Some deposits sit where that cannot be done safely — on the underside of the breastbone, for instance, close to the large veins returning blood to the heart. A needle cannot be passed through that safely, so the tissue cannot be obtained the usual way.
That matters when the treatment being planned depends on knowing what the lesion is. Targeted radiotherapy to a single deposit, for example, is generally offered only once the diagnosis is confirmed. Without tissue, the treatment cannot proceed. In that situation the operation is not the treatment — it is what makes the treatment possible.
It is worth understanding this distinction if it applies to you, because it changes what success looks like. The operation has succeeded when it produces a definite answer — whatever that answer turns out to be. Occasionally the tissue shows something nobody expected, and the whole plan changes for the better as a result.
They are a chain of small lymph nodes lying inside the chest wall, running alongside the breastbone behind the rib cartilages. Most people have never heard of them, including many who have been treated for breast cancer. Breast tissue drains to them, which is why breast cancer can involve them, and their position — tucked behind the front of the rib cage — makes them awkward to reach by conventional surgery.
Robotic surgery suits this anatomy particularly well. Working through small incisions between the ribs, with instruments that articulate in confined spaces and a magnified view, allows these nodes to be reached and removed in a way that is difficult by other approaches. Patients are generally in hospital for a short stay.
This is not a routine treatment. Removing internal mammary nodes is not something offered to everyone whose breast cancer has involved lymph nodes. It is considered in an unusual and specific configuration: where disease in that chain is the dominant remaining problem, the breast cancer itself is controlled, and the breast oncology team agrees that local control of those nodes is worth pursuing. Patients reach this operation through specialist breast multidisciplinary teams. Clinical detail for referring colleagues →
A spot on the lung. Removing a small number of lung deposits is considered in selected patients after systemic treatment, on the recommendation of the breast multidisciplinary team. One point is worth knowing, because it is not widely appreciated: a new single spot on the lung in someone previously treated for breast cancer is not always breast cancer. It can be a new and entirely separate lung cancer, and the two are treated very differently. Telling them apart needs a sample — which is one of the reasons an operation is sometimes advised even where the spot is small.
Cancer spread to the lungs — what it means and when surgery helps →
Fluid around the lung. Breast cancer is one of the commoner causes of fluid collecting between the lung and the chest wall, which causes breathlessness and tends to return after it is drained. Fluid sent to the laboratory on its own gives the answer in only some cases, so where the diagnosis matters a keyhole operation may be advised — taking tissue from the lining, draining the fluid, and where the lung re-expands, treating the space so the fluid does not come back. Where the lung does not re-expand, a thin drain that stays in place and is emptied at home is usually the better answer.
Treatment for breast cancer changes quickly, and tissue removed at an operation is often the most informative material available about a particular cancer. Research teams, or the oncologist who referred you, sometimes ask whether a sample can be kept for research or stored in a biobank.
This is always a separate question from your treatment, and it is always your choice. Declining changes nothing about the operation you have or the care you receive. If it applies to you, someone will explain what is being asked and you will be given time to decide. Nothing is taken for research without your agreement, and enough tissue is always kept for the tests your own treatment depends on.
Usually not, and it would be wrong to imply otherwise. For most people whose breast cancer has spread, the disease is controlled rather than cured, and it is controlled principally with whole-body treatment. Removing one deposit does not change that arithmetic on its own.
What surgery can do, in the right patient, is more specific and worth having: give a definite diagnosis where scans cannot; make a treatment possible that otherwise could not be given; or remove a single site of disease where everything else is under control. Those are real benefits and they are worth pursuing when the situation fits. They are not the same as cure, and a surgeon who blurs the two is not doing you a service.
A question worth asking directly. Whoever you see, ask what this particular operation is expected to achieve in your particular case — diagnosis, enabling another treatment, or local control — and what happens if you do not have it. You should expect a clear answer to both. If the answer is vague, that is useful information in itself.
Most patients are referred by their breast team. If your team has suggested a thoracic surgical opinion, they can refer directly and appointments are usually available within 2–3 working days at London Bridge Hospital or The Lister Hospital Chelsea, with outpatient consultations also available at the HCA clinics in Canary Wharf and the City of London.
Second opinions. Independent review is a reasonable step before committing to an operation — and equally reasonable if you have been told surgery is not possible and want that view tested. Bring your scans, your pathology reports and the outcome of your breast multidisciplinary meeting. Second opinion service →
Self-referrals are welcome. One thing to know if you contact the practice directly rather than through your team: your case will be discussed at the London Bridge Hospital chest multidisciplinary team before any surgical decision is made. You are never asked to commit to an operation on the strength of a single private consultation, and multidisciplinary governance is not bypassed because care is private.
Questions most often asked by patients and families whose breast team has raised the possibility of an operation in the chest.
Book a Consultation →Or call Jo Mitchelson:
020 7952 2882
Appointments at London Bridge Hospital and The Lister Hospital Chelsea within 2–3 working days. Dr Okiror reviews imaging personally and explains clearly what an operation would and would not be expected to achieve. Self-referrals welcome, and are discussed at the chest multidisciplinary team before any surgical decision.
Jo Mitchelson, PA · 020 7952 2882 · pa@lungsurgeon.co.uk
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Plain-English guide to lung deposits from another cancer — what it means and when surgery can help
Fluid Around the LungsKeyhole biopsy, talc pleurodesis and PleurX drains for fluid that keeps coming back
Chest Wall Resection & ReconstructionHow the chest wall is removed and rebuilt when a tumour involves the ribs or breastbone
Pulmonary MetastasectomyClinical detail for referring colleagues — selection, evidence, technique and the multidisciplinary pathway
Specialist Second OpinionIndependent review of imaging, pathology and the surgical recommendation before you commit
Thoracic Symptom ManagementSymptom-directed care — relieving breathlessness, pain, cough and recurrent chest fluid