Breast-conserving surgery (BCS) is an operation to remove the cancer while leaving as much normal breast as possible. Some surrounding healthy tissue and lymph nodes are usually also removed. How much of the breast is removed depends on the size and location of the tumor and other factors. Breast-conserving surgery is sometimes called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. It’s often an option for a woman with early-stage cancer, and allows her to keep most of her breast.
Breast-conserving surgery (BCS) is a good option for many women with early-stage cancers. The main advantage is that a woman keeps most of her breast. However, she will in most cases also need radiation therapy, given by a radiation oncologist (a doctor who specializes in radiation). Women who have their entire breast removed (mastectomy) for early stage cancers are less likely to need radiation, but they may be referred to a radiation oncologistfor evaluation because each patient’s cancer is unique.
BCS might be a good option if you:
This type of surgery is typically done in an outpatient surgery center, 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 how extensive their surgery was.
Ask a member of your health care team how to care for your surgery site and affected arm. Usually, you and your caregivers will get written instructions about care after surgery. These instructions should cover:
Side effects of breast-conserving surgery can include:
As with all operations, bleeding and infection at the surgery site are also possible. If axillary lymph nodes are also removed, other side effects such as lymphedema may occur.
During the surgery, the surgeon will try to remove all of the cancer, plus some surrounding normal tissue.
After surgery is complete, a doctor, called 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 said to have 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 said to have positive margins.
The presence of 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. This operation is 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.
Before your surgery, talk to your breast surgeon about how breast-conserving surgery might change the look of your breast. The larger the portion of breast removed, the more likely it is that you will see a change in the shape of the breast afterward. If your breasts look very different after surgery, it may be possible to have some type of reconstructive surgery or to have the size of the unaffected breast reduced to make the breasts more symmetrical (even). It may even be possible to have this done during the initial surgery. It's very important to talk with your doctor (and possibly a plastic surgeon) before the cancer surgery to get an idea of how your breasts are likely to look afterward, and to learn what your options might be.
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 (which will show up on x-rays) may be placed inside the breast during surgery to mark the area.
Many women receive hormone therapy after surgery to help lower the risk of the cancer coming back. Some women might also need chemotherapy after surgery. If so, radiation therapy is usually delayed until the chemotherapy is completed.