Breast-Conserving Surgery

The goal of breast-conserving surgery is to minimize the risk of local recurrence while leaving a cosmetically acceptable breast.

The extent of resection is determined by the extent of cancer as assessed clinically or by scans such as mammogram, ultrasound, or magnetic resonance imaging. Incisions are usually made directly over the area of the tumor. For nonpalpable tumors, preoperative wire localization may help to guide the resection. Preservation of subcutaneous tissue and avoidance of thick skin flaps helps to maintain normal breast contour. During surgery, gross examination of the margins is performed. Additionally, examination by frozen section or touch-prep cytology can be done intraoperatively to assess margins. Positive margins are re-excised to achieve a margin of normal tissue around the tumor. Radiation therapy must follow breast-conserving surgery.

Candidates for breast-conserving surgery include

• Those in whom removal of the tumor with adequate margins can be accomplished with acceptable cosmesis
• Patients who can be expected to tolerate the radiation therapy regimen.

Patients who are not candidates for breast-conserving surgery include

• Those for whom radiation therapy is contraindicated.

Morrow, M. (2004). Techniques in surgery: Lumpectomy for palpable and nonpalpable cancer. In J.R. Harris, M.E. Lippman, M. Morrow, & C.K. Osborne (Eds.), Diseases of the breast (3rd ed., pp. 819–825). Philadelphia: Lippincott Williams & Wilkins.