What breast-conserving surgery is
The aim is to remove the cancerous tumour together with the necessary margin of healthy tissue and to keep the rest of the breast. The operation is also called lumpectomy, segmental mastectomy or partial mastectomy; all describe the same logic.
Its extent depends on the size and position of the tumour and on the characteristics of the breast tissue. In the past many patients diagnosed with breast cancer had to have the whole breast removed; today, in suitable patients, the breast tissue can be preserved.
In suitable patients no difference in survival has been shown between breast-conserving surgery and mastectomy. That removes the need to decide on the principle that more removal is always safer.
Who it suits
Breast-conserving surgery may not be suitable for every patient. Several factors are weighed together:
- The size and position of the tumour and the number of tumours
- Breast volume and the size of the tumour relative to it
- The stage of the disease and how widely it is spread within the breast
- Treatment already given, in particular radiotherapy to the same breast
- Whether radiotherapy can be given after the operation
In some patients chemotherapy or other systemic treatment is given first to shrink the tumour, which then makes breast-conserving surgery possible. The decision is therefore not based on the tumour size measured at diagnosis alone.
If the tumour has spread to more than one area of the breast, if the same breast has previously been irradiated, or if clear margins cannot be achieved, removing the whole breast is safer.
How the operation is done
Examination, mammography, ultrasound and, where needed, MRI are assessed together to establish the position and borders of the tumour. Tumours that cannot be felt are marked before the operation.
The incision is planned and the tumour is removed with the necessary margin of healthy tissue around it. The removed tissue is sent for pathological examination.
Sentinel lymph node biopsy is performed where needed. In selected patients with spread, wider surgery to the armpit lymph nodes may be carried out.
If the amount of tissue removed or the position of the tumour would leave a deformity, the remaining tissue is rearranged with oncoplastic techniques in the same session.
The margins and the characteristics of the tumour are reported, usually within a week. If there is a problem with the margins, further surgery may be needed.
Radiotherapy after surgery
After breast-conserving surgery radiotherapy is needed in almost every patient and clearly reduces the risk of recurrence. Surgery and radiotherapy are one whole; accepting the operation but not planning radiotherapy is not a sound path.
If you are not in a position to receive radiotherapy, breast-conserving surgery is usually not a suitable option. This is one of the first things we discuss when the surgical decision is made.
Depending on the pathology result, chemotherapy, hormone therapy or targeted treatment may also be considered. The treatment plan is drawn up jointly by surgery, radiation oncology and medical oncology.
Frequently asked questions
The decision is made by weighing the characteristics of the tumour, how widely the disease is spread, the structure of the breast and the other treatments available. For some patients conserving surgery is a suitable option; for others mastectomy is safer.
It is needed in most patients. The treatments required depend on the characteristics of the tumour, but if you cannot receive radiotherapy the surgical plan changes too.
Most of the breast tissue is kept, but there is tissue loss where the tumour was removed. In suitable patients oncoplastic techniques help to preserve the shape of the breast.
If it recurs in the same breast, mastectomy is usually required. This is why follow-up and annual imaging after surgery must be kept up.