Inclusion Criteria:

          1. >40 years with MIBC, with the largest clinical cancer measuring 50mm as part of
             multifocal or multicentric "disease sites". 50mm may include the size of a single
             cancer and its surrounding small satellite cancers (6, 7). Clinically diagnosed
             (ultrasound and biopsy) either axillary lymph node negative or positive where axillary
             treatment depends on local policy

          2. Two disease foci with a minimum of one invasive focus of breast cancer as defined
             within a "disease site"

          3. Suitable for TM (best practice) using one large lumpectomy (multifocal) or any number
             of "distant" lumpectomies (multicentric) to excise "disease sites"

          4. Fit for adjuvant therapy as per pre-operative evaluations (ECG, Chest X-ray, blood
             biochemistry)

          5. Willing and able to provide written informed consent

        Exclusion Criteria:

          1. Neo-adjuvant therapy

          2. Women considered high risk by local centre or known to have BRCA1/2 gene mutation

          3. Ductal Carcinoma in situ (DCIS) only, and extensive DCIS

          4. Bilateral breast cancers

          5. Previous breast cancer (invasive or DCIS in either breast)

          6. Pregnancy as confirmed on blood tests or ultrasound examination

          7. Metastatic disease

          8. Any previous type of breast radiotherapy

          9. Significant other clinical risk factors and co-morbidities at the discretion of the
             treating clinicians

         10. Previous or concomitant malignancy except adequately treated: non-melanomatous skin
             cancer; in situ carcinoma of the cervix and in situ melanoma