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What is breast-conserving surgery?

There are two basic categories of surgery for breast cancer: mastectomy and breast-conserving surgery. Mastectomy is the removal of the entire breast. Two types of breast-conserving surgery are lumpectomy and quadrantectomy (also called a partial mastectomy). Although the volume of tissue removed may be slightly different, the fundamental idea behind breast-conserving surgery is to remove the tumor and a margin of surrounding normal tissue to ensure that all the cancerous tissue has been removed.

Breast-conserving surgery has the obvious advantages of less surgery, easier recovery and usually very good cosmetic results that allow a woman to maintain her natural breast, her own nipple and normal sensation.

Dr. Stuart A. Linder, MD
Plastic Surgeon

Patients who have stage 1 or stage 2 breast cancer may undergo breast conserving surgery in which only a lumpectomy or a partial mastectomy with radiation and possible axillary lymph node dissection is performed. As a result, the remaining portion of the breast as well as the nipple areolar complex will be conserved allowing for a more normal appearance of the breast. Patients who have positive margins and require reexcision may require a complete mastectomy with radiation therapy. It is most important that the pathological diagnosis of the specimen and the surrounding margins of the tissue be evaluated. It is most important that all cancer be removed rather than preserving tissue. However, in cases in which a small amount of tissue, including stage 1 or 2 breast cancer is found, a lumpectomy with axillary lymph node dissection and radiation may offer an excellent final appearance to the breast with a simple reconstructive surgery.

In breast-conserving surgery only a part of the affected breast is removed, although how much is removed depends on the size and location of the tumor and other factors. If radiation therapy is to be given after surgery, small metallic clips (which will show up on x-rays) may be placed inside the breast during surgery to mark the area for the radiation treatments.

Lumpectomy removes only the breast lump and a surrounding margin of normal tissue. Radiation therapy is usually given after a lumpectomy. If adjuvant chemotherapy is to be given as well, radiation is usually delayed until the chemotherapy is completed.

Partial (segmental) mastectomy or quadrantectomy removes more breast tissue than a lumpectomy. For a quadrantectomy, one-quarter of the breast is removed. Radiation therapy is usually given after surgery. Again, this may be delayed if chemotherapy is to be given as well.

If cancer cells are found at any of the edges of the piece of tissue removed, it is said to have positive margins. When no cancer cells are found at the edges of the tissue, it is said to have negative or clear margins. The presence of positive margins means that that some cancer cells may have been left behind after surgery. If the pathologist finds positive margins in the tissue removed by breast-conserving surgery, the surgeon may need to go back and remove more tissue. This operation is called a re-excision. If the surgeon can't remove enough breast tissue to get clear surgical margins, a mastectomy may be needed.

For most women with stage I or II breast cancer, breast-conservation therapy (lumpectomy/partial mastectomy plus radiation therapy) is as effective as mastectomy. Survival rates of women treated with these two approaches are the same. However, breast-conservation therapy is not an option for all women with breast cancer (see "Choosing between lumpectomy and mastectomy" below).

Radiation therapy can sometimes be omitted as a part of breast-conserving therapy. Although this is somewhat controversial, women may consider lumpectomy without radiation therapy if all of the following are true:

  • they are age 70 years or older
  • they have a tumor 2 cm or less that has been completely removed (with clear margins)
  • the tumor is hormone receptor-positive, and the women is getting hormone therapy (such as tamoxifen or an aromatase inhibitor)
  • no lymph nodes contained cancer

You should discuss this possibility with your healthcare team.

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Important: This content reflects information from various individuals and organizations and may offer alternative or opposing points of view. It should not be used for medical advice, diagnosis or treatment. As always, you should consult with your healthcare provider about your specific health needs.