Breast Conservation Surgery

Each year thousands of women in the UK face breast cancer. Today the options for treatment are much better and more widely available than ever before. If you are undergoing surgery for breast cancer then it may be possible to choose to have only part of the breast removed during what is called breast conservation surgery. Also known as lumpectomy, or segmental mastectomy, this option may be available if the cancer is localised in a small area of the breast. Some women have a full mastectomy and choose to have breast reconstruction either immediately or after they have healed from the initial operation. Those who have breast conservation surgery may not feel that they require reconstruction and remain satisfied with the appearance of their breasts if little tissue was removed.

Discussing Your Options

Decisions about your breast surgery will depend on a number of personal factors, including the stage of your breast cancer, your overall health and the size of your natural breasts. You may choose to have implants after mastectomy, or feel perfectly comfortable with the size and shape of your breasts after surgery with no need for reconstruction. Some women choose to wear a prosthesis inside their bra to balance the appearance of the breasts. If you are very thin then you may not have enough body tissue for a flap graft to take place, making it important to understand your options prior to undergoing initial surgery. For some women a full mastectomy might feel like the better option compared to breast conservation surgery in terms of prophylaxis for recurrence of breast cancer.

The Extent of Tissue Removal

There are a number of variations in breast conservation surgery including a wide local excision which refers to the removal of a cuff of normal tissue radially around the cancer. A segmental resection is the removal of the tumour with a further segment orientated towards the nipple. A quadrantectomy refers to the removal of the quadrant of the breast containing the cancer. The need, or desire, for reconstruction depends largely on how much of the breast tissue is to be removed during the mastectomy. In most cases this can be determined prior to surgery, offering you the option of choosing whether or not to have reconstruction at the same time. On occasion the malignant tissue may be more extensive than thought prior to surgery and you may opt for reconstruction after the breast conservation surgery despite having not felt it necessary previously.

Nipple Removal and Reconstruction

Larger defects caused by the removal of breast tissue during breast conservation surgery can be repaired primarily by using tissue from the back, or adjacent area. Larger tumours may be treated primarily with chemotherapy in an attempt to shrink them prior to your surgery, thus increasing the possibility of breast conservation surgery being an option rather than a full mastectomy. Central tumours may necessitate the removal of the nipple and areolar complex with nipple reconstruction performed, if you desire, at a later date.

Adjuvant Radiotherapy Treatment

If you have multifocal breast cancer or extensive Ductal Carcinoma in situ (DCIS) then breast conservation may not be an option for you, with a full mastectomy more advantageous in removing the cancerous tissue. Adjuvant radiotherapy is usually undertaken alongside breast conservation surgery in order to reduce the risk of recurrent breast cancer. Additional chemotherapy and endocrine therapy may also be necessary and you should discuss these possibilities with your oncologist prior to making treatment decisions.