Breast conservation surgery: you may not need to lose your breast

One of the first questions a woman asks after a breast cancer diagnosis is whether she will lose her breast. For many patients the answer is no. Decades of research have shown that for suitable tumours, removing the lump with a clear margin and following it with radiation gives the same survival as removing the whole breast.

What is breast conservation surgery?

Also called lumpectomy or wide local excision, it removes the tumour together with a rim of healthy tissue. The rest of the breast is preserved. Radiation therapy to the breast is then given over a few weeks to treat any microscopic cells that may remain.

What is oncoplastic surgery?

When the tumour is large relative to the breast, a simple lumpectomy can leave a dent or distortion. Oncoplastic techniques borrow from plastic surgery: the tumour is removed and the remaining breast tissue is rearranged, or the breast is reduced and lifted, in the same operation. The opposite breast can be adjusted for symmetry. The result is a natural shape and, often, a better cosmetic outcome than before surgery.

Who is suitable?

• Tumours that are small relative to the breast size, or that have shrunk after chemotherapy
• A single tumour, or multiple tumours in the same quadrant that can be removed together
• Patients who can receive radiation afterwards

Conservation may not be advised for very extensive disease, inflammatory breast cancer, or patients who cannot have radiation.

What about the lymph nodes?

In most early cancers, a sentinel lymph node biopsy identifies and tests only the first one to three draining nodes. If they are clear, the rest of the armpit nodes are left alone, greatly reducing the risk of arm swelling (lymphoedema).

The bottom line

Breast cancer surgery today is about treating the cancer completely while protecting the woman's body image and quality of life. Discuss conservation and oncoplastic options with a surgical oncologist before deciding on treatment.