Surgeries That Conserve the Breast

Some of the same factors that caused radical mastectomy to fall from favor also prompted the development of breast-conservation surgery. The realization that mastectomy did not cure all cancers, the use of mammography to identify smaller and smaller cancers, and the success of radiation therapy following surgery all suggested that it was not necessary to always remove the entire breast.

For most women, surgery that leaves most of the breast intact, followed by radiation therapy, is as effective as mastectomy for long-term survival. This is especially true if the cancer is occurring in only one portion of the breast. However, if the cancer is present in several areas of the breast (called multifocal breast cancer), lumpectomy and radiation may not be the best choice.

The terms "lumpectomy," "wide excision," and "partial mastectomy" are used interchangeably to describe surgeries in which only the cancer and a margin of surrounding cancer-free tissue is removed (see Lumpectomy/Partial Mastectomy). If examination of the tissue that is removed shows that cancer is present at its margin, the surgeon can remove additional tissue in a procedure called a reexcision. Lumpectomy is nearly always followed by radiation therapy.

Very little, if any, skin is removed during breast-conservation surgery, and, if possible, the incision is located so it won't show when you're wearing a bathing suit or low-cut dress. Surgery for invasive cancers usually includes removal and analysis of the axillary lymph nodes to see if the cancer has spread to them. Surgery is usually performed with intravenous sedation with local anesthesia, a spinal block, or general anesthesia. (Also see After Surgery.) In some situations, such as when the cancer is relatively large in relation to the breast, chemotherapy and/or hormonal therapy can be used before surgery to shrink the tumor and allow for less tissue removal and breast distortion.

If the lump is small and your breast is medium or large, the cosmetic change may not be noticeable. Removal of a large tumor from a small breast, however, can involve a substantial loss of breast tissue and may disfigure the breast. The breast that's been operated on may now be smaller than and a different shape from your other breast. Also, the nipple area may be off-center or shaped differently.

Speak with your surgeon in advance about what changes to expect in the size and shape of your breast, the placement of the surgical scar, and its length. You might be able to minimize the cosmetic changes by having neoadjuvant chemotherapy to shrink the tumor before surgery. Neoadjuvant chemotherapy is becoming increasingly common, particularly for T2 and T3 breast cancers, as a means of optimizing appearance after lumpectomy. If a noticeable size discrepancy between your breasts seems likely, consider having a mastectomy and breast reconstruction, instead. Or, as another alternative, you can choose a reduction mammoplasty, a procedure in which the second breast is reduced in size.

Next >> Lymph Node Surgery

In This Article:
Treating Breast Cancer
Local and Systemic Treatments
Breast Surgery
Mastectomy
Surgeries That Conserve the Breast
Lymph Node Surgery
Radiation Therapy

From the Harvard Health Publications Special Health Report, Breast Cancer: Strategies for Living. Copyright 2004 by the President and Fellows of Harvard College. Illustrations by Harriet Greenfield, M.A., and Jesse Tarantino. All rights reserved. Used with permission of StayWell. Harvard Medical School does not endorse products.
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