What is breast conserving surgery?

It is a good option especially when the breast cancer is in a single area and the tumor is small. Although there are names such as segmentectomy, quadrantectomy, lumpectomy, it basically refers to the removal of a certain part of the breast. In this method, the patient gets rid of the anxiety of losing the breast completely and the mental problems that will be caused by the subsequent cosmetic deficiency.

It is mostly done under general anesthesia. It is passed under the skin with a horizontal or parallel incision to the nipple edge. It is removed to surround the relevant breast part with healthy tissue without ever entering the breast cancer part. The borders of the excised area are marked and sent for pathological evaluation. In order to drain the accumulated fluid after the surgery, a drain (vacuum pipe system) is placed and the skin is closed. The hospital stay is 1 day if everything goes well.

Although rapid pathological evaluation, called frozen section, is used in some cases, only permanent pathological evaluation can give the information that the borders are free from tumor after a few days. This information is very important. Because sometimes tumor cells can progress through channels at a microscopic level without being clearly palpable. This is only revealed in the pathology evaluation. If cancer cells are detected at the border, surgery is required again.

Radiotherapy is an integral part of breast-conserving surgery. Because after partial surgery, there is a possibility of recurrence of the disease in the related breast. Even if radiotherapy is applied, the probability of recurrence of the disease in the breast within 10 years is around 15%. However, this recurrence does not affect the probability of survival (survival). At that time, the breast can be removed or breast-conserving surgery can be performed again. In other words, there is no difference in survival between removal and preservation of the breast in suitable cancers.

Breast conserving surgery is not suitable for some patients and cancer types.

Breast preservation may not be appropriate in small volume breasts and large tumors. Because when there is a lot of tissue to be taken, the remaining breast tissue may not be cosmetically satisfactory.

In large tumors, the cancer can sometimes be shrunk with neoadjuvant chemotherapy. In this way, breast-conserving surgery may be possible. But this treatment takes several months before surgery. Waiting during this period may be difficult for some patients. In fact, the tumor may not shrink very rarely during this period.

Breast protection is not appropriate for tumors located under the nipple. There is a risk of the tumor spreading through channels under the nipple, which is the central station point. In addition, cosmetic insufficiency will be evident after the nipple is removed. Even neoadjuvant therapy does not change this.

It is not possible to protect the breast in tumors with more than one focus in the breast. This condition is evaluated with preoperative imaging methods (mostly magnetic resonance imaging). Cancer types such as ductal carcinoma in situ or lobular carcinoma are also likely to be multifocal. Until recently, breast-conserving surgery was not performed in such tumors. However, nowadays, wide-limited breast-conserving surgery can be considered in this type of tumors, considering the high recurrence and borderline tumor risks.

I perform breast-conserving surgery in approximately 40% of my patients. In the remaining patients, either the tumor is not suitable for breast-conserving surgery, or the patient wants the entire breast to be removed.

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