Breast-conserving surgery

Lumpectomy 02

Breast-conserving surgery (BCS), also known as lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy, is a less invasive surgery option for patients with breast cancer. Unlike mastectomy, which involves the removal of the entire breast, breast-conserving surgery aims to remove only the cancerous tissue and a small margin of surrounding healthy tissue. This approach allows for the preservation of most of the breast. It is typically followed by radiation therapy to eliminate any remaining cancer cells, providing a treatment approach that balances effective cancer control with cosmetic outcomes.

Indications

Breast-conserving surgery is most commonly indicated for patients with early-stage breast cancer where the tumor is small relative to the size of the breast, allowing for complete removal while leaving a cosmetically acceptable breast. The feasibility of BCS depends on various factors, including the size and location of the tumor, the breast size, the presence of multiple tumors, and the patient's personal preference. Patients with larger tumors may still be candidates for BCS after undergoing neoadjuvant chemotherapy to shrink the tumor before surgery.

Procedure

The BCS procedure involves the surgical removal of the cancerous tumor along with a rim of normal breast tissue surrounding it, known as the surgical margin. The goal is to ensure that no cancer cells remain at the edges of the removed tissue. The size of the margin can vary, but the aim is always to achieve "clear margins," which means no cancer cells are found at the outer edge of the removed tissue. The surgery is usually performed under general anesthesia. In some cases, a sentinel lymph node biopsy (SLNB) or axillary lymph node dissection (ALND) may be performed during the same operation to check if the cancer has spread to the lymph nodes.

Advantages and Disadvantages

The primary advantage of breast-conserving surgery is the preservation of most of the breast, which can lead to better cosmetic outcomes and potentially less psychological impact compared to mastectomy. Studies have shown that, when combined with radiation therapy, BCS offers the same survival rates as mastectomy for early-stage breast cancer.

However, BCS is not without its disadvantages. The requirement for radiation therapy almost always follows BCS, which can be inconvenient and may have its own side effects. Additionally, there is a risk of cancer recurrence in the remaining breast tissue, and some patients may require re-excision if the margins are not clear of cancer cells.

Follow-up and Aftercare

Follow-up care after breast-conserving surgery includes regular mammograms to monitor the treated breast and the contralateral breast for any signs of new or recurring cancer. Patients may also undergo hormone therapy or targeted therapy if their cancer is found to be sensitive to these treatments. The cosmetic results of BCS can vary, and some patients may opt for breast reconstruction or corrective surgery to improve the appearance of the breast after treatment.

Conclusion

Breast-conserving surgery represents a significant advancement in the treatment of breast cancer, offering an effective alternative to mastectomy for many patients. By focusing on the removal of cancerous tissue while preserving as much of the breast as possible, BCS can provide effective cancer control along with a focus on the patient's quality of life and cosmetic satisfaction.