Breast Conserving Surgery

Breast conserving surgery offers women with early breast cancer a way to remove the tumor while keeping most of their breast tissue intact, achieving survival rates equal to mastectomy when combined with radiation therapy.

Table of contents

• What is Breast Conserving Surgery?
• Who Can Have This Surgery?
• The Surgical Procedure
• Finding Small Cancers During Surgery
• Lymph Node Surgery
• Preparing for Surgery
• What to Expect After Surgery
• Recovery and Side Effects
• Changes to Your Breast
• Follow-Up Treatment

lumpectomy, wide local excision, partial mastectomy, quadrantectomy

What is Breast Conserving Surgery?

Breast conserving surgery is a treatment that removes cancer from the breast while leaving as much healthy breast tissue as possible^[1]. This type of surgery has several names. Doctors may call it a lumpectomy (when removing the breast tumor and a surrounding margin of normal tissue), a wide local excision, or a partial mastectomy or quadrantectomy (when removing more breast tissue, sometimes up to one-quarter of the breast)^[2][3].

The surgeon removes the area of cancer along with a border of normal breast tissue all around it. This border is called a margin. The goal is to ensure that no cancer cells remain at the edge of the removed tissue^[2]. Studies have shown that women with early-stage breast cancer who have breast conserving surgery followed by radiation therapy have survival rates equal to women who have a mastectomy (complete breast removal)^[5][8].

Who Can Have This Surgery?

Breast conserving surgery may be a good option for you if the cancer is small compared to your breast size, in a suitable position, and only in one area of your breast^[2]. Your doctor may recommend this surgery if you have stage I or stage II breast cancer^[5].

This surgery usually works best for tumors under 4 cm in size^[5]. The location of the tumor matters too. Tumors near the nipple may require removal of the nipple, but this is not a reason you cannot have breast conserving surgery^[15]. Having positive lymph nodes (lymph nodes that contain cancer cells) does not prevent you from having this type of surgery^[15].

However, breast conserving surgery may not be right for everyone. This surgery is usually not suitable if you cannot have radiation therapy after the operation^[2]. Your doctor will discuss your specific situation and help you decide which surgery is best for you.

The Surgical Procedure

Breast conserving surgery is usually performed under general anesthesia, meaning you will be asleep during the operation^[3]. The surgery typically takes about one hour^[3].

During the operation, the surgeon makes an incision (cut) in your breast. They remove the cancer along with some normal breast tissue around it to create a clear margin^[2]. A pathologist (a doctor who studies tissue) checks the border around the tumor for cancer cells. If there are no cancer cells at the edge, your report will say there is a clear margin. Clear margins are important because they mean you are less likely to need more surgery and have a lower risk of cancer coming back^[2].

If cancer cells are found at the edge of the removed tissue, you may need another surgery to remove more tissue. This is called a re-excision. A mastectomy may be needed if clear surgical margins cannot be achieved^[3].

Finding Small Cancers During Surgery

Some early cancers are found through scans such as mammograms, ultrasounds, or MRI scans. These cancers may be too small for your surgeon to feel. They are called non-palpable or occult lesions^[2].

Surgeons use different techniques to locate these small cancers. One common method is wire guided localization. This involves putting a thin wire into the breast tissue to show the surgeon exactly where to operate. You usually have the wire placed on the morning of your surgery while having an ultrasound or mammogram^[2].

Another approach is non-wire guided localization. Your surgeon might use different types of markers, such as a magnetic marker, radioactive liquid or seed, an electromagnetic wave reflector, or a radiofrequency tag. Depending on which type you have, the marker may be placed on the day of surgery, the day before, or up to a few weeks beforehand^[2].

Lymph Node Surgery

Lymph nodes are small glands that filter bacteria, viruses, and cancer cells from the body. The lymph nodes near the breast, located in the armpit (called axillary lymph nodes), are one of the first places breast cancer can spread^[4][8].

Your surgeon may remove some lymph nodes to check if the cancer has spread. This is usually done at the same time as your breast surgery^[4]. The most common procedure is called a sentinel lymph node biopsy, which removes one or a few lymph nodes for testing^[8]. If cancer is found in these nodes, all of the lymph nodes may need to be removed.

Preparing for Surgery

Before your surgery, you will need some tests to make sure you are healthy enough for the operation. These may include blood work, a medical evaluation, a chest x-ray, and an EKG (a test that checks your heart), depending on your age and medical condition^[3].

Your surgeon will explain the potential risks and benefits of the operation, and you will need to provide written consent for surgery^[3]. You will also meet with an anesthesiologist (the doctor who gives you medicine to make you sleep during surgery) to discuss your medical history, any allergies, and the plan for anesthesia^[4].

There are several things you need to do before surgery:

• Stop eating and drinking after midnight the night before your operation, except for medications your doctor tells you to take with a sip of water^[3]
• Stop taking certain medications such as aspirin, blood thinners, anti-inflammatory medications, and large doses of Vitamin E several days to a week before surgery^[3]
• Do not use diet medications or St. John’s Wort for two weeks before surgery^[3]
• Quit smoking if you smoke^[3]
• Shower with antibacterial soap the night before or morning of the operation^[3]
• Arrange for help at home during your recovery^[3]

What to Expect After Surgery

Most people who have breast conserving surgery go home the same day^[2]. Some people may stay in the hospital for one to three days, depending on whether they also had lymph node surgery or breast reconstruction^[4].

After surgery, you will have a scar on your breast. You usually cannot see this scar when you wear a bra or swimming costume. If you had lymph nodes removed, you will also have a scar under your armpit. These scars will fade over time^[2].

You may wake up from surgery wearing a surgical bra. This bra will stay in place for a while. You may be able to get a second surgical bra to take home so you can alternate them for washing^[4].

Recovery and Side Effects

Recovery from breast conserving surgery typically takes about one to two weeks^[6]. Most people can engage in light activity and resume normal activities within a day or two, including driving, walking up stairs, light lifting, and work^[3][6].

You will generally be told not to lift anything heavier than a gallon of milk for a few weeks. The more involved your surgery is, the longer your recovery will be and the more restrictions you will have on activities such as pushing, pulling, and lifting your arms over your head^[4].

You can usually remove any dressings and shower the day after the operation^[3]. However, if you have surgical drains, you may be told not to shower until they are removed. Most patients are told not to shower until the surgical drains are removed^[6].

Common side effects after breast conserving surgery include:

• Temporary pain and swelling at the surgery site^[3][6]
• Temporary breast swelling^[6]
• Bruising^[6]
• Feeling sick (nausea)^[2]
• Numbness or change in sensation near the incision^[6]
• A clear fluid collection called a seroma in the wound^[6]
• Hardness due to scar tissue at the incision site^[6]

Post-operative pain is generally mild, and most patients need only a pain pill or pain medication^[3]. Swelling is a normal part of the healing process and should lessen six to eight weeks after surgery. If the swelling is uncomfortable and feels heavy, you may want to wear a supportive bra day and night^[2].

Less common complications can include wound infection, bleeding, and swelling of the arm called lymphedema if lymph nodes were removed^[6].

You should call your doctor right away if you have:

• A fever over 101 degrees F (39 degrees C) that continues^[3]
• Redness, tenderness, swelling, or warmth at the wound site^[2]
• Fluid or discharge from the wound^[2]
• Feeling generally unwell^[2]

It usually takes about two to three weeks for skin to heal and around 10 weeks for any internal stitches to dissolve^[2].

Changes to Your Breast

Breast conserving surgery may not change the look of your breast very much^[2]. However, in some women the breast might be smaller after surgery. There may also be a change in the shape and size of the breast or a change in skin texture or color, especially after radiation^[6].

The larger the portion of breast removed, the more likely it is that there will be some change to the breast after surgery. If your breasts may look very different after surgery, it may be possible to have some type of reconstructive surgery, or to have the other breast reduced in size to make the breasts more similar in appearance. Immediate reconstruction may be possible during the initial surgery^[3].

It is important to talk with your surgeon (and possibly a plastic surgeon) before surgery to get an idea of how your breast is likely to look afterward and to learn what your options might be^[3]. Your surgeon may be able to show you photos of what your breast is likely to look like after the operation^[2].

Follow-Up Treatment

You will usually have radiation therapy after breast conserving surgery. This is given to destroy any cancer cells that may still be in the breast. Radiation helps reduce the risk of cancer coming back in the breast^[2][5].

Studies have shown that breast conserving surgery combined with radiation therapy is as effective as mastectomy for treating early-stage breast cancer. The 10-year survival rates for women with early-stage breast cancer after lumpectomy with radiation or mastectomy is about 80 percent^[16].

If you are also having chemotherapy, the radiation is usually delayed until the chemotherapy is completed^[3]. You may also need hormone therapy or other treatments depending on the type of breast cancer you have^[5].

You should schedule a follow-up appointment within two weeks after your operation^[3]. At this appointment, your doctor will check how you are healing and discuss the results of the surgery and any further treatment you may need.