Breast-conserving Surgery (Lumpectomy)
Breast-conserving surgery (BCS) involves the removal of cancer while leaving as much normal breast as possible. Typically, some surrounding healthy tissue and lymph nodes also are removed. Breast-conserving surgery is sometimes called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy depending on how much tissue is taken out.
Things you should know before having breast-conserving surgery
• The size of breast that is taken out depends on the size and location of the tumor, your breast size and other factors.
• Breast-conserving surgery lets a woman to keep most of her breast, but makes it likely she will also require radiation.
• After BCS, many women will have radiation therapy. Some women might also get other treatments like hormone therapy or chemotherapy.
• Choosing BCS plus radiation over mastectomy does not have effect on a woman’s chances of long-term survival.
• If you think you want breast reconstruction, talk to your doctor prior to your breast cancer surgery.
• Not all women with breast cancer are eligible for breast conserving surgery. Talk to your doctor to find out if BCS is an option for you.
• Side effects of BCS may include pain, a scar and/or dimple at the region where the tumor was removed, a firm or hard surgical scar, and sometimes lymphedema, a type of swelling, in the arm.
Who can have breast-conserving surgery?
BCS might be a good option if you:
• Are very concerned about losing a breast
• Are willing to have radiation therapy and are able to get to the appointments
• Have not had your breast treated with radiation therapy or breast conserving surgery
• Have only one area of cancer in the breast or several areas that are close enough to be removed together without changing the look of the breast too much
• Have a tumor smaller than 5 cm (2 inches), and that is also small compared to the size of the breast
• Are not pregnant or, if pregnant, will not need radiation therapy right away (to avoid risking harm to the fetus)
• Do not have a genetic factor such as a BRCA or ATM mutation, which might increase your chance of a second breast cancer
• Do not have certain serious connective tissue diseases like scleroderma or lupus, which may make you particularly sensitive to the side effects of radiation therapy
• Do not have inflammatory breast cancer
• Do not have positive margins
Side effects of breast-conserving surgery
• Pain or tenderness or a "tugging" sensation in the breast
• Temporary swelling of the breast
• Hard scar tissue and/or a dimple that forms in the surgical site
• Change in the shape of the breast
• Nerve pain (sometimes described as burning or shooting pain) in the chest wall, armpit, and/or arm that don’t go away over time. This can also happen in mastectomy patients and is called post-mastectomy pain syndrome or PMPS.
• If axillary lymph nodes are also removed, other side effects such as lymphedema may occur.
As with all surgical operations, bleeding and infection at the surgery site are also possible.
Was all the cancer removed?
During the BCS, the surgeon will try to take out all the cancer, plus some surrounding normal tissue.
After surgery is finished, a doctor, called a pathologist, will look closely at the tissue that was taken out in the lab. If the pathologist does not find any cancer cells at any of the edges of the removed tissue, it is said to have negative or clear margins. If microscopic(tiny) cancer cells are found at the edges of the tissue, it is then said to have close or positive margins.
Having positive margins implies that some cancer cells may still be in the breast after surgery, so the surgeon may require going back and removing more tissue. This operation is called a re-excision. If cancer cells are still found at the edges of the removed tissue after the second surgical procedure, a mastectomy may be required.
Breast reconstruction surgery after breast-conserving surgery
Prior to your surgery, talk to your breast surgeon about how breast-conserving surgery might change the look of your breast. The bigger the portion of breast removed, the more apt it is that you will see a change in the shape of the breast afterward. If your breasts look a lot different after surgery, it may be possible to have some type of reconstructive surgery or to have the size of the unaffected breast decreased to make the breasts more symmetrical (even). It may even be possible to have this done during the first surgery. It's very important to talk with your doctor (and possibly a plastic surgeon) before the cancer surgery to get an idea of how your breasts are likely to look afterward, and to learn about your alternatives.
Treatment after breast-conserving surgery
Many women will need radiation therapy to the breast after breast-conserving surgery. Sometimes, to make it easier to aim the radiation, small metallic clips (which will show up on x-rays) may be positioned inside the breast during surgery to mark the area.
Most women will have hormone therapy after surgery to help reduce the risk of the cancer coming back. Some women might also require chemotherapy after surgery. If so, radiation therapy and hormone therapy are generally delayed until the chemotherapy is completed.
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