Breast Conservation Surgery

Introduction

Breast conservation surgery is a procedure performed to conserve breast tissue by removing only the cancerous tissue, so that the breast looks normal even after the surgery. A moderate-dose radiation therapy follows the conservation surgery to destroy any residual cancerous cells.

The surgery aims at providing cosmetically aesthetic breasts, low recurrence of cancer, and when combined with radiation therapy,survival equivalent to that of mastectomy (complete removal of the breast tissue).

Indications and Contraindications

Breast-conservation surgery is indicated in women with small cancers that are localized or in early-stage breast cancer. However, the surgery may not be recommended in the following cases:

• Two or more regions of cancerous growth within the same breast
• Large tumours in small breasts
• Pregnancy during radiation therapy
• Tumour bigger than 2 inches that does not reduce with chemotherapy
• Tissue diseases sensitive to radiation
• Left-over tumour from previous breast-conservation surgery

Surgical Procedure

The type of breast conservation surgery will depend on the size, location of tumour, and amount of tissue that has to be removed during the procedure. Breast conservation surgeries can include lumpectomy or partial mastectomy.

Lumpectomy

Lumpectomy involves the removal of the cancerous lump with a margin of the surrounding healthy breast tissue. Lumpectomy can be performed under general or local anaesthesia, and may take about 15-40 minutes. Your surgeon will use an electric scalpel (blade) to make a curved incision across the natural curve of your breast and will remove the tumour along with the surrounding healthy tissue.Another incision near the armpit is made if your surgeon decides to remove the lymph nodes as well. The lump will be sent to the lab to test for the presence of tumour cells in the healthy margin tissues, and the incisions will be closed.

If cancer cells are present in the surrounding tissues removed with the tumour, your surgeon will perform an additional surgery called as re-excision lumpectomy, by re-opening the lumpectomy site and removing a larger margin of the breast tissue.

Partial mastectomy

Partial mastectomy (segmental mastectomy or quadrantectomy) involves the removal of more breast tissue containing cancer, surrounding healthy tissue,and the chest muscles underlying the tumour. It is performed under general anaesthesia.

In certain cases, your surgeon may perform a sentinel lymph node (first lymph nodes to which cancer cells are most likely to spread) biopsy to test for the presence of cancerous cells. If the cancer has spread to the sentinel lymph node, your surgeon may remove the lymph nodes.

Following breast-conservation surgery, you may have to undergo radiation therapy, chemotherapy or hormone therapy in combination,to destroy any residual cancerous cells still remaining in the breasts.

Post-Operative Care

After the breast-conservation surgery, you may be discharged on the same day or within one to two days, depending on whether lymph nodes are removed or not. You should keep the surgical area clean, dry, and follow the bathing instructions given by your doctor. Breast soreness will decrease with time. Your doctor may recommend medicines for relieving pain. You can wear a bra to support your breasts for a few days. You can resume normal activities within two weeks, but should avoid strenuous activities, especially those involving use of your arms.

Consult your doctor if you experience swelling, numbness of breasts,fever and/or chills, or bleeding or drainage from the incision site.

Risks and Complications

As with any surgical procedure, breast-conservation surgery involves potential risks and complications. These may include:

• Disfiguration of breasts
• Lymphedema (accumulation of lymph fluid in the arm)
• Seroma (fluid in the wound)
• Infection and bleeding of wounds
• Hardness at the excision site due to scar formation

Advantages and Disadvantages

Few potential disadvantages of breast conservation surgery include:

• Five to seven weeks of radiation therapy, which may interfere with subsequent reconstruction surgery
• Higher risk of recurrent cancer
• Intolerance to additional radiation if new cancer develops
• Need for additional re-excision surgeries

However, breast conservation surgery preserves the appearance and sensation of the breasts, is a less invasive procedure, and has a shorter recovery time than that of mastectomy.