Breast-conserving surgery, or BCS, removes cancer while leaving as much normal breast as possible. Generally, some surrounding healthy tissue and lymph nodes also are removed.  While breast-conserving surgery is safe and has benefits, BCS also makes it likely that you’ll need radiation treatment.

Breast-conserving surgery is sometimes called:

  • Lumpectomy
  • Quadrantectomy
  • Partial mastectomy
  • Segmental mastectomy, depending on how much tissue is removed

How much of the breast is removed depends on the size and location of the tumor and breast size. After BCS, most patients will be treated with one or more of the following:

  • Radiation therapy
  • Hormone therapy
  • Chemotherapy

It is imperative to note that choosing BCS plus radiation over mastectomy does not affect a woman’s chances of long-term survival.

Who is a Good Candidate For Breast-Conserving Surgery?

Breast-conserving surgery is a good option for many women with early-stage cancers who want to keep most of their breasts. Women with their entire breasts removed for early-stage cancers are less likely to need radiation, but they may still be referred to a radiation oncologist for evaluation. 

BCS might be a good option if you:

  • Are concerned about losing a breast
  • Are willing to have radiation therapy
  • Have not already had that breast treated with radiation therapy or BCS
  • Have only one area of cancer in the breast
  • Have multiple areas of cancer in one location  that are close enough to be removed together without significantly changing the look of the breast
  • Have a tumor smaller than two inches, which is also small relative to the size of the breast
  • Are not pregnant or, if pregnant, will not need radiation therapy immediately
  • Do not have BRCA or ATM mutation, which might increase your chance of a second breast cancer
  • Do not have serious connective tissue diseases such as scleroderma or Sjögren's syndrome, which may make you sensitive to the side effects of radiation therapy
  • Do not have inflammatory breast cancer
  • Do not have positive margins

What to Expect Before & During BCS

A few days before your breast-conserving surgery, you'll meet with your surgeon to ask questions and ensure you understand the procedure and its risks. You'll also be given instructions regarding pre-surgical restrictions and other relevant information.

Breast-conserving surgery begins with a mammogram or ultrasound to locate the tumor before inserting a thin wire, needle, or tiny radioactive seed. This acts as a guide toward the precise area that needs to be removed during surgery. However, the localization procedure may not be necessary if you have a lump or mass in your breast that Dr. Rancati can quickly feel through the skin.

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Your Ariel Center surgeon may also recommend removing lymph nodes near your armpit to see whether cancer has spread beyond the breast if the cancer is in its early stages. Lymph node removal procedures include:

  • Node biopsy, which removes only the first one or two nodes into which cancer drains to be tested for cancer
  • Axillary lymph node dissection, which removes several lymph nodes from your armpit, especially if a lymph node biopsy is done before surgery and shows signs of cancer

During BCS, you’ll be put under general anesthesia while your surgeon makes an incision over the area that contains the wire or seed. After removing the tumor and some surrounding tissue, they will send it to a lab for analysis.

Your Ariel Center surgeon closes the incisions with attention to preserving the appearance of your breast, using sutures that will either dissolve on their own or be removed later. They may also place thin adhesive strips or glue on the incision to keep it closed until it heals.

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Recovery, results, & When to Expect them

After your surgery, your care team will bring you to a recovery room, where they will monitor your blood pressure, pulse, and breathing. If you've had outpatient surgery, you'll be released when your condition is stable; however, if you've had a more extensive procedure or experiencing pain or bleeding, you may need to stay in the hospital for up to two days.

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Expect to have:

  • A bandage over the surgery site
  • Some pain, numbness, and a pinching sensation in your underarm area
  • Prescriptions for pain medication and possibly an antibiotic
  • Some restricted activity
  • A follow-up appointment with your doctor one to two weeks after surgery

Most women can function after going home and return to regular activities within two weeks, while some may need help at home depending on how extensive their surgery was.

Following aftercare instructions is exceptionally important for the results of your BCS. These instructions generally include the following information:

  • How to care for the surgery site and dressing
  • Signs of infection
  • When to call the doctor or nurse
  • When to start using your arm again
  • How to do arm exercises to prevent stiffness
  • When you can resume wearing a bra
  • Activity restrictions
  • What to expect regarding side effects
  • What to expect regarding feelings about body image
  • When to see your doctor for a follow-up appointment

The results of your procedure should be available in a few days to one week. Your doctor will explain the results at the follow-up visit after your surgery. If you need more treatment, your doctor may recommend meeting with a surgeon or other oncologist to discuss your options.

Are There Any Risks or Side Effects?

Side effects of BCS may include:

  • Pain or tenderness
  • Bleeding and infection at the surgery site
  • A tugging sensation in the breast
  • A scar or dimple where your doctor removed the tumor
  • A firm or hard surgical scar
  • Swelling in the arm
  • Change in the shape of the breast
  • Nerve pain in the chest wall, armpit, or arm that doesn’t go away over time
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