Breast-conserving surgery (also known as BCS, lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy) is an operation to remove the cancer while leaving as much normal breast as possible. Some surrounding healthy tissue and lymph nodes may also be removed. How much of the breast is removed depends on many factors, including the size and location of the tumor.
Important points to know about breast-conserving surgery:
- BCS allows a woman to keep most of her breast.
- Not all women with breast cancer are candidates for BCS. Talk to your doctor to find out whether BCS is an option for you.
- Studies show that choosing BCS (plus radiation) over mastectomy does not affect a woman’s chances of long-term survival.
- If you think you may want breast reconstruction, talk to your surgeon before your breast cancer surgery.
- After BCS, most women will need radiation therapy and some may need other treatments as well, such as hormone therapy or chemotherapy.
- Side effects of BCS may include pain, a scar and/or dimple where the tumor was removed, a firm or hard surgical scar and (a type of swelling) in the arm.
Who is it for?
Breast-conserving surgery is an option for many women with early-stage cancer. The main advantage is that a woman keeps most of her breast. However, in most cases, she will also need radiation therapy. Women with early-stage cancer who have their entire breast removed through a mastectomy are less likely to need radiation, but they may be referred to a radiation oncologist (a doctor who specializes in radiation for the treatment of cancer) for evaluation.
Breast-conserving surgery might be a good option for women:
- Very concerned about losing their breast
- Willing to have radiation therapy
- Have not already had their breast treated with radiation therapy or breast-conserving surgery
- Have only one area of cancer on the breast, or multiple areas that are close enough to be removed together without changing much of the look of the breast
- Have a small tumor (5 cm/2 inches or smaller), which is also small relative to breast size
- Who are not pregnant or, if pregnant, will not need radiation therapy immediately
- Do not have a genetic factor such as a BRCA mutation, which might increase the chance of a second cancer
- Do not have certain serious connective tissue diseases such as scleroderma or lupus, which may cause sensitivity to the side effects of radiation therapy
- Do not have inflammatory breast cancer
Breast-conserving surgery is typically done on an outpatient basis, and an overnight stay in the hospital is usually not needed. Most women should be fairly functional after going home and can often return to their regular activities within 2 weeks. Some women may need help at home depending on the extensiveness of their surgery.
Ask a member of your surgical team how to care for your surgery site and affected arm. You and your caregivers will be given written instructions about care after surgery. These instructions should cover:
- When to call the doctor or nurse
- How to care for the surgical site and dressing
- How to care for your drain, if you have one (A drain is a plastic or rubber tube coming out of the surgical site that removes the fluid that collects during healing.)
- How to recognize signs of infection
- Bathing and showering after surgery
- When to start using your arm again and how to do exercises to prevent it from becoming stiff
- When you can start wearing a bra again
- What to eat and what not to eat
- Use of medicines, including pain medicines and possibly antibiotics
- Any restrictions on activity
- What to expect regarding sensations or numbness in the breast and arm
- What to expect regarding feelings about body image
- When to see your doctor for a follow-up appointment
Side effects of breast-conserving surgery can include:
- Pain or tenderness or a “tugging” sensation in the breast
- Temporary swelling
- Hard scar tissue that forms in the surgical site
- Change in the shape of the breast
- Nerve (neuropathic) pain sometimes described as burning or shooting pain in the chest wall, armpit and/or arm that doesn’t go away over time. This can also happen in mastectomy patients and is called post-mastectomy pain syndrome or PMPS.
As with all surgical procedures, bleeding and infection at the surgical site are also possible. If axillary (underarm) lymph nodes are also removed, other side effects such as lymphedema (a type of swelling) may occur.
How can doctors be sure all of the cancer was removed?
During the surgery, the surgeon will try to remove all of the cancer, plus some surrounding normal tissue.
After surgery is complete, a pathologist will use a microscope to look at the tissue that was removed. If the pathologist finds no cancer cells at any of the edges of the removed tissue, it is considered as having negative or clear margins. Sometimes breast cancer cells spread past what the imaging studies are able to show. So if microscopic (smaller than the human eye can see) cancer cells are found at the edges of the tissue, it is considered as having positive margins.
Positive margins means that some cancer cells may still be in the breast after surgery, so the surgeon may need to go back and remove more tissue in an operation called a re-excision. If cancer cells are still found at the edges of the removed tissue after the second surgery, a mastectomy may be needed.
Is breast reconstruction needed after breast-conserving surgery?
In general, women who have breast-conserving surgery do not have reconstruction. However, for some of these women, the surgeon may reshape the breast at the time of cancer surgery. This type of breast-conserving surgery is called oncoplastic surgery. Oncoplastic surgery combines the plastic surgery techniques of breast reconstruction with breast surgical oncology to improve cosmetic results and minimize the effects of cancer treatment. When a large lumpectomy or partial mastectomy is required that will leave the breast distorted, oncoplastic surgery sculpts the remaining tissue to realign the nipple and areola and restore a natural appearance to the breast shape. The opposite breast may also be modified to create symmetry. With oncoplastic surgery, the breast is reconstructed at the same time that the lumpectomy or partial mastectomy is performed. The goal is to preserve the physical appearance of the natural breasts and remove the cancer during one surgery. There are various oncoplastic surgery options, and they depend on the breast cancer characteristics, each patient’s body and the patient’s desired outcomes.
Before your surgery, talk to your breast surgeon about how breast-conserving surgery may change the look of your breast and whether you are a candidate for oncoplastic surgery.
Will more treatment be needed after breast-conserving surgery?
Most women will need radiation therapy to the breast after breast-conserving surgery. Sometimes, to make it easier to aim the radiation, small metallic clips may be placed inside the breast during surgery to mark the area for doctors to see on x-rays.
Many women receive hormone therapy after surgery to help lower the risk of the cancer returning. Some women may also need chemotherapy after surgery. If so, usually chemotherapy is completed before radiation therapy begins.
Make an appointment
Wondering whether breast-conserving surgery is an option for you? Massey’s breast surgeons can answer your questions, discuss your goals and preferences and help you determine the best surgical options for you. To schedule an appointment with a Massey surgical oncologist, please call us at (877) 4-MASSEY.