1.Breast-conserving surgery means that for breast cancer patients who are suitable for breast preservation, we do an extended tumor excision, do pathological examinations of the upper, lower, inner, outer, surface and bottom of the tumor to ensure that the tumor is removed cleanly and the breast is preserved, and add whole breast radiation therapy after surgery. This is one of the most common ways we use for breast cancer surgery at present.
2. Benefits of breast-conserving surgery.
(1) The surgery is less invasive and does not require removal of the entire breast.
Most women do not want to lose their breasts, so breast-conserving surgery minimizes the impact on their appearance.
(3) It is easy to live after the surgery, so you don’t need to put a foreign body on when you go out, and it doesn’t affect your participation in any group activities or sports, such as swimming.
(4) The impact on the family life of the couple is small.
3.Is breast-conserving surgery safe? This is the most important question for our patients. If the tumor has already grown in the breast, is it more likely to recur? Breast-conserving surgery has been performed since the 1970s, and a large number of clinical studies worldwide have confirmed that for patients who are suitable for breast-conserving surgery, there is no difference in the chance of local recurrence and overall survival rate between breast-conserving surgery plus whole-breast radiotherapy and mastectomy, and some studies suggest that the survival of breast-conserving patients is even better than that of mastectomy patients. Therefore, breast-conserving surgery is now widely carried out worldwide. In Europe, the United States and other economically developed countries, breast-conserving surgery accounts for about 60% of breast cancer surgery, while the proportion in our country is less than 20%.
4. In principle, breast-conserving surgery must be combined with whole-breast radiotherapy, but how much damage does whole-breast radiotherapy do to the body? Some patients give up breast-conserving surgery because they are afraid of radiotherapy. However, due to the rapid progress of radiotherapy technology, the damage is becoming smaller and smaller, and most patients can tolerate it. In addition, even without breast conservation, some patients still need radiotherapy, such as those with metastasis in axillary lymph nodes, tumor invading skin, chest wall, lumps larger than 5cm, etc.
5.What are the circumstances under which we cannot choose breast-conserving surgery? There are only 3 absolute contraindications for breast-conserving surgery.
If the pathological examination tells us that there are still tumor cells on the cut surface, then we have to do local excision and pathological examination again. If tumor cells can still be seen, then we usually give up breast-conserving surgery and change to mastectomy combined or not combined with stage I breast reconstruction.
(2) It is expected that there are no conditions for radiotherapy after surgery, such as having had radiotherapy to the breast or chest wall in a short period of time, no equipment or technical conditions for radiotherapy, the patient’s own objective conditions, etc.
(3) There are also patients who have various considerations to refuse breast-conservation, so the doctor can not give breast-conservation to the patient.
6.What cases should we be careful in choosing breast-conserving surgery?
(1) There are multiple lesions in the breast that are suspected to be malignant, which we call multicentric or multifocal lesions.
(2) Those with diffuse mucocele-like calcifications in the breast that are more extensive.
(3) If genetic testing has been done, there are carriers of oncogenes BRCA1 and BRCA2.
(4) Those with active connective tissue disease, such as lupus erythematosus, have some difficulty with radiation therapy.
In these cases, although breast conservation is not absolutely impossible, the risk of local recurrence is relatively high, so breast conservation should be done with caution.
7. In which cases can we safely choose breast-conserving surgery? In cases where the lump in the breast is relatively small, the tumor can be completely removed while ensuring the aesthetic appearance of the breast after surgery, and there are conditions to complete post-surgical radiotherapy. For some larger lumps, we can also use oncoplastic techniques to ensure the aesthetic appearance.
In conclusion, breast-conserving surgery is a safe and reasonable choice under the right conditions, and the benefits it brings far outweigh the disadvantages. Of course, each patient’s situation is different, and whether it is suitable to choose breast-conserving surgery requires detailed communication with one’s primary care physician, listening to the doctor’s advice, as well as combining one’s own considerations and family’s opinions to make a reasonable choice.