Breast Conservative Surgery / Lumpectomy / Wide Excision
Lumpectomy is surgery in which only the tumour and a rim of surrounding breast tissue is removed. It is a form of breast conserving surgery to preserve the original shape of the breast
Not all breast cancer cases are offered lumpectomy. It depends on the size of the breast tumor in relation to the breast size. Tumor size generally less than 3cm can be offered breast conserving surgery / lumpectomy
Indications for BCS
- Cosmetic outcome – pt wishes to preserve that breast shape
- Minimal breast tissue excision
- Avoid reconstruction and or prosthesis
Factors that favor BCS / Lumpectomy
- Small size tumour less than 3cm to 4cm
- Monocentric tumour ( tumour/s within the same quadrant of the breast
- Patient is suitable for radiation therapy
- Younger age.
- Localisation of tumor
- Patient compliance.
Contraindication for BCS
- Multicentric tumor
- Diffuse (malignant microcalcifications)
- Previous radiation therapy to the chest wall.
- Locally wide spread tumour
- Size more than 4-5cm if the breast volume is small
- Patients with BRCA gene mutation (relative contraindication)
Understanding limitations and expectations of BCS
- Most women will need Radiation therapy after BCS as this will reduce the local recurrence rate from 30-40% (without radiotherapy) to 5-8% (with radiotherapy
- Edge of the margins may have cancer cells in 10% of the cases and as such, further surgery is needed for re-excision for clearing the margins.
Importance of Clear margins for breast conserving surgery
Local recurrence is higher in lumpectomy compared to total mastectomy. It is also higher if the edge of the cut margins are involved.
Data research and recommendation NCCN/SSP/ASTRO guidelines has concluded that “negative ink margins / no ink on tumour “ has been accepted as the standard practice world-wide. This means that there are no cancer cells noted on the outer edge of the ink margin from microscopic assessment of histopathological specimen of the breast cancer tissue
IF the margins are involved with cancer cells, then further re-excision of the cavity is necessary.
