Surgery For Breast Cancer

In these types of 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 2 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 health care team.

Possible side effects: Side effects of these operations can include pain, temporary swelling, tenderness, and hard scar tissue that forms in the surgical site. As with all operations, bleeding and infection at the surgery site are also possible.

The larger the portion of breast removed, the more likely it is that there will be a noticeable change in the shape of the breast afterward. If the breasts look very different after surgery, it may be possible to have some type of reconstructive surgery (see the section"Reconstructive Surgery" ), or to have the unaffected breast reduced in size to make the breasts more symmetrical. 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 surgery to get an idea of how your breasts are likely to look afterward, and to learn what your options might be.

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