Who is breast-conserving surgery suitable for?
The size and position of the tumour and its ratio to breast volume decide. Why radiotherapy is an inseparable part of it.
The deciding measure is a ratio
In breast-conserving surgery the tumour is removed with a margin of healthy tissue around it, and the rest of the breast stays in place. In suitable patients, no difference in survival has been shown between this and removing the whole breast. Conserving surgery does not mean compromising on safety.
What decides is not the size of the tumour in centimetres but its size relative to the volume of the breast. A three-centimetre tumour is a problem in a small breast, while the same tumour can be removed comfortably from a large one.
- The size and position of the tumour in the breast
- Whether it is in a single focus or several
- Breast volume and the degree of existing sagging
- Whether you are able to receive radiotherapy after surgery
- Your own expectations about appearance
When conserving surgery is not suitable
If the tumour sits in several areas of the breast, removing all of them with clear margins would leave an unacceptable deformity.
If tumour cells are seen at the surgical margin during the operation or in the pathology report, a further procedure is needed. When that repeats, removing the breast is safer.
If the same breast has been irradiated before, or something prevents radiotherapy, conserving surgery is not preferred.
Suspicious microcalcifications spread over a wide area on mammography can mean the disease is more extensive than it looks.
Some items on this list are not absolute barriers. A large tumour, for example, can be shrunk with drug treatment first and so become suitable for conserving surgery. Oncoplastic techniques also make it possible to remove more tissue while preserving the shape of the breast.
Why radiotherapy is inseparable
After breast-conserving surgery, microscopic cells may remain in the breast tissue left behind. Radiotherapy targets that possibility and clearly reduces the risk of the disease returning in the same breast.
Surgery and radiotherapy are therefore a single package. Accepting the operation without planning radiotherapy removes the ground conserving surgery stands on. If you are not able to have radiotherapy, it is sounder to discuss mastectomy from the outset.
Radiotherapy usually begins a few weeks after surgery, is left until after chemotherapy if that is needed, and mostly takes three to five weeks.
When the result becomes clear
Swelling, firmness and altered sensation are normal in the first weeks. The final shape settles within a few months, together with the effect of radiotherapy. That is why we do not judge the result by the first month.
Follow-up continues with examinations every six months in the early years and annual imaging. Keeping your check-ups in the same place is preferable, as it makes the images easier to compare.
The content on this site is for general information and does not replace an examination by a physician. If you have symptoms, please book an appointment.
← All articles