Everything You Need to Know About Breast-Conserving Surgery

If faced with a breast cancer diagnosis, it is important to know that breast-conserving surgery (BCS) is a viable treatment option. This procedure involves removing the area of your breast where the tumor is located. It may be referred to as lumpectomy, wide local excision, partial mastectomy, quadrantectomy, or segmental mastectomy. During BCS, a surgeon will carefully remove the tumor as well as some healthy tissue surrounding it (known as a margin) through surgery. The amount of breast tissue removed will depend on several factors, such as the size and location of the tumor, as well as breast size. This can be a difficult and emotional time, but support and guidance from healthcare professionals will always be present throughout this period.

BCS may not be appropriate for all breast cancer patients. BCS may be more applicable for cases where:

• The tumor is small compared to the breast
• The tumor is in a suitable position of the breast
• Tumor(s) is only in one area of the breast or are in multiple areas in one quadrant (multifocal) that are close enough
• The patient is able to have radiation therapy after BCS

Healthcare providers will guide patients through the various treatment options.

BCS is usually done under general anesthesia. An incision will be made over or near the breast tumor and the tumor and the area around it will be removed. In some cases, the surgeon might want to hide the scar and place it either in the bra line below or on the side of the breast or around the areola. If any lymph nodes are to be removed, a separate cut will be made in or near the armpit. Once all the tissue has been removed, it will be sent to a laboratory to be examined by a pathologist.

The margin of the tissue sample will be checked for any cancer cells. A negative or clear margin means there are noinvasive or non-invasive cancer cells found at the margin. If cancer cells are found, it is said to have a positive margin. Having a positive margin means that more tissue needs to be surgically removed in a re-excision operation. In some occasions mastectomy may be needed to remove the whole breast if more cancer cells are still found after the second surgery.

Patients undergoing the BCS procedure can expect a safe and efficient experience that typically takes about 1 to 1.5 hours. Most BCS patients are able to go home on the same day. If there are complications after the surgery, you may need to stay in the hospital for one or two more days. Rest assured that you will receive the best possible treatment and support throughout their recovery.

• Bleeding at the surgery site
• Wound infection
• Pain, tenderness, numbness, and/or “tugging” sensation in the breast that may last for a few weeks
• Temporary swelling of the breast
• Change in size and shape of the breast
• Hard scar tissue at the incision site
• Swelling of the breast due to an accumulation of fluid (seroma) that may need to be drained by a health professional

If lymph nodes were removed, other possible complications can happen, depending on the type of surgery, which include:

• Swelling of the arm (lymphedema) may develop a few months or years after surgery
• Bruising or swelling under the arm
• Tingling or mild pain in the arm, armpit, or shoulder (may improve over time, but some changes may also be permanent or last a long time)
• Restriction of shoulder and arm movement and that is why it is important to follow the physiotherapy instructions given to you

The majority of breast cancer patients are given radiation therapy after BCS to decrease the chance of the cancer recurring in the breast. Hormone therapy, chemotherapy and other treatments may also be recommended depending on each case. If chemotherapy is necessary, radiation therapy or hormone therapy will only be administered after the chemotherapy is complete.

Undergoing BCS can be a difficult experience, as it may lead to changes in the size and shape of your breasts. It is important to keep in mind that reconstructive surgery may be an option to minimize any changes and improve symmetry for the affected and unaffected breasts, respectively. This may involve making adjustments to the affected breast or reducing the size of the unaffected one.

It is advisable to have a thorough conversation with a doctor about these options before the initial BCS procedure to determine the best course of action that meets the patient’s individual needs and concerns. During this process, you will have the needed support and expert guidance of healthcare professionals every step of the way. Their reassuring presence will give you the confidence and peace of mind to navigate their journey with ease.