When breast cancer is detected early and the tumour is still small, it can often be treated by removing just the area of abnormal tissue, rather than the whole breast.
This allows the rest of the breast to be preserved, and a more normal appearance maintained.
Because the rest of the breast tissue is being retained, this surgery is followed by a course of breast radiation therapy to reduce the risk of cancer recurring in the breast in the future.
Who can have breast conserving surgery?
Breast conserving surgery is usually suited to women who fit these criteria:
- have cancers which measure less than 3cm in diameter (sometimes larger if there is adequate breast volume)
- tumour(s) confined to one quadrant of the breast
- have enough breast volume to allow removal of the tumour without causing the breast to be distorted
- are able to undergo breast radiation therapy (required for invasive disease, but not always for small volume DCIS).
Breast conserving surgery is usually not suitable for women who:
- have a large tumour and small breast volume
- have multiple tumours in the breast, encompassing more than one quadrant
- have extensive high-grade DCIS or locally advanced cancer
- are in the 1st or 2nd trimester of pregnancy
- are unable to undergo radiation treatment.
Newer breast reconstruction techniques can enable some women with larger tumours to have breast conserving surgery, in conjunction with reconstruction of the defect using tissue flaps. You could ask your surgeon whether this might be possible for you.
Breast conserving surgery is usually not suitable for men and is not the safest option for women with BRCA1 or 2 mutations (except perhaps as initial cancer management when future preventative mastectomies and reconstructive surgery is planned after all adjuvant treatment has been completed).
The surgery
Breast conserving surgery involves removing the tumour along with a small amount of healthy surrounding tissue – this is to ensure that the cancer has been completely removed. The aim of this procedure is to remove the cancer but also leave the breast looking as natural as possible. A small scar will be visible on the breast in the area where the tumour was located, or if possible this may be placed around the edge of the areola.
The surgery will be performed in a hospital and require either a day or an overnight stay.
Wire-localised excision
If the cancer is very small or can’t be felt, a radiologist will use ultrasound or mammography to visualise the area and insert a fine wire which will guide the surgeon to the area for removal. This is often referred to as hook wire or D-wire localisation and is always used in screen-detected DCIS cases.
Surgical margins and further surgery
After breast conserving surgery the pathologist closely examines the edges (margins) of the removed tissue to ensure that there is a rim of healthy breast tissue around the tumour, indicating that the cancer has been completely removed.
If there are cancerous or pre-cancerous (DCIS) cells at the edge of the specimen, another operation may be required to remove more tissue. This is usually done by simply re-excising the involved area of the cavity. However, if there are cancer cells remaining over a wide area, mastectomy may be recommended.
Recovery
The length of time it will take you to recover from breast conserving surgery often depends on whether lymph nodes were removed from under your arm at the same time. If the surgery is performed for DCIS, no lymph node surgery is required.
You shouldn’t drive until your movements are pain-free, and should avoid heavy lifting to reduce the risk of post-operative bleeding. Your surgeon will advise you about time off work.
A soft, supportive, non-underwired bra is recommended during the healing phase. In the immediate post-op period you may feel more comfortable if you also wear this at night.
If the surgery results in noticeable asymmetry in breast size or shape, the Ministry of Health provides funding for a partial prosthesis and pocketed bras. Read more here
Radiation therapy
When breast cancer is treated with breast conserving surgery, it is followed by a course of radiation therapy to eradicate microscopic disease and decrease the chance of cancer recurring in the remaining breast tissue.