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Breast-conserving surgery avoids removing the entire breast
Breast-conserving surgery (BCS, also known as breast conservation surgery and segmental mastectomy) is a less radical cancer surgery than mastectomy. Breast-conserving surgery, as in a lumpectomy removes part of the breast tissue during surgery, as opposed to the entire breast.
For clinical stages I and II breast cancer, breast-conserving surgery, with radiotherapy and possibly chemotherapy may be indicated if one or two sentinel lymph nodes are found to have cancer which is not extensive. In this case, the sentinel lymph nodes would be examined, and lymphadenectomy as further evaluation is not indicated as this result from the sentinel lymph nodes is sufficient to recommend treatment.
In the selection of patients for breast conservation treatment with radiation, there are some absolute and relative contraindications.
Absolute contraindications, which are reasons why the procedure absolutely cannot be done, include:
- Pregnancy is an absolute contraindication to the use of breast irradiation. In some cases, it may be possible to perform breast-conserving surgery in the third trimester and treat the patient with radiation after delivery.
- Two or more primary tumors in separate quadrants of the breast or with diffuse malignant-appearing microcalcifications.
- A history of prior therapeutic irradiation to the breast that would require re-treatment to an excessively high total dose.
- Persistent positive margins after reasonable surgical attempts: the importance of a single focally positive microscopic margin needs further study and may not be an absolute contraindication.
Breast conserving therapy
Breast conserving therapy (BCT) is the process of following up BCS with moderate dose radiation therapy in order to eliminate residual disease in the breast and decrease the likelihood of disease recurrence. The goal of this process is to give the patient an equivalent survival rate to mastectomy while limiting cosmetic damage caused by surgery. Six recent clinical trials concluded that BCT was successful in that goal. However, not all patients are suitable for BCT and for some mastectomy may still be required (cf. Contraindications).
Oncoplastic surgery is a form of breast-conserving surgery that integrates plastic surgery techniques into breast cancer surgery in order to preserve aesthetic outcomes and quality of life, without compromising local control of the cancer. It is based on three surgical principles: ideal breast cancer surgery with free tumor margins, immediate breast reconstruction, and immediate symmetry with the other breast.
- American College of Surgeons (September 2013), "Five Things Physicians and Patients Should Question", Choosing Wisely: an initiative of the ABIM Foundation, American College of Surgeons, retrieved 2 January 2013
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- Breast conserving therapy, UpToDate. Mar 17, 2014
- Bertozzi, N; Pesce, M; Santi, PL; Raposio, E (June 2017). "Oncoplastic breast surgery: comprehensive review". European review for medical and pharmacological sciences. 21 (11): 2572–2585. PMID 28678328.