Breast Conserving Surgery
Also known as:
lumpectomy, Breast preservation surgery, partial mastectomy, re-excision, quadrantectomy, wedge resection, tylectomy, segmental excision, wide excision
Breast-conserving surgery removes the cancer or abnormal tissue, but leaves the rest of the breast intact. The goal is to take just enough tissue so that the breast looks as normal as possible after the surgery, but the chance of the cancer coming back is low. Breast conserving surgery, followed by radiation treatment, is now the preferred method of treatment for many women with early stage breast cancer.
Breast conserving surgery can mean many things including a biopsy, lumpectomy, partial mastectomy, wedge resection, or having a quarter of the breast taken (quadrantectomy).
- In a lumpectomy, the surgeon cuts out the tumor and some of the breast tissue around it. You may also hear this called an "excisional biopsy" or "wide excision."
- In a partial or segmental mastectomy, the surgeon cuts out the tumor and a larger section of breast tissue around it. The lining over the chest muscles below the tumor may also be removed, but most of your breast remains.
You should make sure you have a clear understanding from your surgeon about how much of your breast may be gone after surgery and what kind of scar you will have.
Lymph node dissection.
Lymph nodes are often removed during surgery and examined for the presence of cancer cells. Cancer cells in the lymph nodes may indicate a higher chance that cancer cells have spread to other parts of the body, and may indicate the need for additional treatment. Lymph node removal falls into two categories:
- Sentinel lymph node biopsy (SLNB). The surgeon removes the first one or two nodes into which a tumor drains, known as sentinel nodes. These nodes are examined under a microscope to check for cancer cells. If cancer is found in those lymph nodes, more lymph nodes may be removed.
- Axillary lymph node dissection (ALND). The surgeon removes some or all of the lymph nodes in your axilla (your armpit). This is usually done if tests performed before your surgery suggests that there is cancer in the lymph nodes.
Most people who have breast-conserving surgery also have radiation therapy. You may also have chemotherapy, hormone therapy, or both.
What to expect after surgery
A lumpectomy can be done with local anesthesia if you are not having lymph nodes removed. If you are having lymph nodes removed or are having a partial mastectomy or quadrantectomy, you will have general anesthesia.
After your surgery, you will be taken to a recovery room. A nurse will be able to help with any nausea, pain, or anxiety you might have.
Many people go home the day of the surgery, but you may stay in the hospital for a day or two. Your doctor or nurse will give you instructions on pain control and caring for the surgical wound.
Most people are able to get back to normal activity within a few days. But be sure to wait for your doctor to tell you when you can start with more strenuous physical activity. This will depend on the extent of the surgery and on other treatment you might be having.
If you are going to have radiation therapy, it will not start until the wound heals. This usually takes at least 2 weeks.
Why it is done
Breast-conserving surgery is done in early-stage breast cancer to remove as much cancer as possible and give the greatest chance of a cure.
How well it works and contraindications
For early-stage breast cancer, breast-conserving surgery with radiation therapy has the same survival rate as mastectomy.1
But, not all women are candidates for breast conserving surgery, including:
- women who have already had radiation therapy to the affected breast or chest wall, or who have already had a lumpectomy that did not completely removed the cancer (recurring local cancer)
- women with inflammatory breast cancer
- women with large tumors; two or more primary tumors; or diffuse, malignant-appearing microcalcifications in the breast.
- women who may not be able to undergo radiation therapy, such as those with connective tissue disease or who are pregnant (except patients in the third trimester who can receive radiation after the child is born)
- women with a cancer that is large relative to her breast size, which might result in an unappealing cosmetic result
- women with a high risk for breast cancer who opt for prophylactic (preventative) removal of the breasts
- male breast cancer patients
Complications of breast-conserving surgery are unusual but include infection, bleeding, poor wound healing, or a reaction to the anesthesia used in surgery. Blood or clear fluid may also collect in the wound and need to be drained. You may have feelings of pulling, pinching, tingling, or numbness.
What to think about
The more breast tissue that is removed during this surgery, the more likely it is that there will be a noticeable change in the breast afterwards. Experts suggest that before having breast-conserving surgery, women talk with their doctors (and possibly a plastic surgeon) about what their breasts might look like after the surgery.
Breast-conserving surgery can be considered after the cancer has been staged. Breast-conserving surgery may not be the best choice in some cases, depending on the size of the tumor or if there are several tumors that are too far apart.
Breast-conserving surgery is usually followed by radiation. If you don't want to have radiation therapy or if you cannot have radiation treatment, breast-conserving surgery is not usually a good choice.
Radiation therapy has to be done on a set schedule and takes several weeks. If you do not think you can go to every appointment, talk to your doctor about other treatment options.
Surgery is almost always recommended to treat breast cancer. If breast-conserving surgery is not a good option for you, then total or modified radical mastectomy, which removes the entire breast and sometimes the surrounding tissue, is a better treatment choice.
- Fisher B, et al. (2002). Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New England Journal of Medicine, 347(16): 1233–1241.