Breast conserving surgery preserves the breast and only removes the tumor. Other synonyms are: lumpectomy, segmental or partial mastectomy and quadrantectomy. This is the most frequent type of surgery (applied in 60% to 70% of the cases).
This type of surgery means the breast is kept and in most cases its appearance is normal thanks to reconstructive surgery (oncoplastic surgery) that is conducted immediately after the initial cancer treatment surgery. Most often scarring won’t be visible, except in some rare cases where some scars may show in the cleavage.
What happens during breast conserving surgery?
This surgery is generally carried out under general anesthetic. The surgeon makes an incision into the breast and:
- If the lesion is easily felt it is removed at this stage.
- If the lesion is not easy to feel (which is very frequently the case) then it will have already been identified by the radiologist who uses a wire localization technique. This entails positioning the tip of a thin steel wire within the area to be removed (for example an area of microcalcifications, an area that is distorted or one that is excessively dense…) The surgeon follows the wire and removes the tissue that the wire is in contact with. Once the sample is removed it is x-rayed to verify that abnormal zone has been totally removed.
In the operating theater the anatomopathologist takes over for:
- a first analysis (called extemporaneous as it is conducted almost immediately after the surgery whilst the patient is still asleep) that confirms the presence of cancer and indicates if more surgical treatment work can be done,
- otherwise the sample is sent to the anatomopathologist for a laboratory analysis that keeps the tissue intact and in principle renders the best possible diagnosis. A separate further round of surgery may then be required according to the laboratory results.
Once the tissue is removed, the surgeon then proceeds to correct any breast shape defects using oncoplasty. The surgeon repairs the ‘defect’, closes the wound and sometimes leaves a drain in (a small tube to collect any blood) for 24 or 48 hours.
In general the patient does not suffer post-operative pain, although some temporary discomfort may be experienced with perhaps even a feeling of induration that may last some weeks in the area that has been operated.
If it has been confirmed that the cancer is invasive, in all cases a sentinel lymph node dissection will be carried out at the same time as the initial surgery.
Moreover, after breast conserving surgery, radiotherapy treatment is almost always required in order to avoid any local recurrence.