Breast-conserving surgery, also known as lumpectomy or wide local excision, is a surgical procedure used to remove breast cancers, while preserving as much of the healthy breast tissue as possible.

Breast-conserving surgery is typically recommended for early-stage breast cancer (stage 0, I, or II) where the tumour is relatively small and localized within the breast. It may also be an option for certain cases of ductal carcinoma in situ (DCIS), a non-invasive form of breast cancer.

Breast-conserving surgery offers several potential benefits compared to mastectomy, including:

• Preservation of the breast shape and appearance.
• Faster recovery time and shorter hospital stay.
• Reduced psychological impact associated with losing the entire breast.
• Similar long-term survival rates compared to mastectomy for early-stage breast cancer.
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Triple assessment is used to diagnose breast cancers, and is over 99% sensitive.  This involves:

1. Clinical assessment by your surgeon, including history and examination
2. Imaging – mammogram, ultrasound +/- MRI
3. Biopsy – Needle biopsy done under image guidance in radiology

Procedure: During breast-conserving surgery, the tumour is removed along with a margin of surrounding normal tissue. The goal is to achieve clear surgical margins, meaning that no cancer cells are present at the edges of the tissue removed. The extent of tissue removal varies depending on factors such as the size and location of the tumour.

Breast Reconstruction: In some cases, breast-conserving surgery may be followed by breast reconstruction procedures to improve the cosmetic appearance of the breast. This may involve techniques such as breast implants, tissue expanders, tissue flaps (using tissue from other parts of the body) or breast mammoplasty. Breast symmetrising surgery may also be offered at the same time as the cancer surgery if appropriate.

Sentinel Lymph Node Biopsy: In addition to removing the tumour, a sentinel lymph node biopsy during breast-conserving surgery may be performed to assess whether cancer has spread to the draining ‘gate-keeper’ lymph nodes. This involves identifying and removing one or more sentinel lymph nodes, which are the first lymph nodes to which cancer cells are likely to spread. You will be asked to have a lymphoscintogram prior to surgery to help localise these nodes, and patent blue dye will be injected into the breast on the day of surgery.

Lymph node surgery : Prior to surgery, you will need to have one of the dual dyes injected, which helps to localise the sentinel node on the day of surgery.  This is a lymphoscintigram [Technetium-99 radiolabelled dye], which is injected behind the nipple at a medical imaging centre within 24 hours of your planned surgery.  This will be arranged at your clinic appointment.

Breast surgery :

An MRI of the breasts is often also used in the work-up of breast-conserving surgery.

For lesions that are not palpable – ie small and precancerous lesions [ie DCIS], a hookwire is sometimes placed on the day of surgery to help localise the lesion.  The hookwire placement will be checked with a post hookwire mammogram.

Radiation therapy : Following breast-conserving surgery, most patients receive radiation therapy to the remaining breast tissue. Radiation helps destroy any remaining cancer cells and reduces the risk of cancer recurrence in the treated breast. The combination of breast-conserving surgery and radiation therapy has been shown to be as effective as mastectomy for early-stage breast cancer in terms of long-term survival rates.

Hormone therapy & chemotherapy : Depending on the characteristics of the tumour and other factors, patients may also receive adjuvant therapy, such as chemotherapy, hormone therapy, or targeted therapy, to reduce the risk of cancer recurrence and improve outcomes.

After breast-conserving surgery, patients require regular follow-up appointments with their surgeon and oncologist for a minimum period of 5 years, to monitor for any signs of cancer recurrence and to assess the effectiveness of adjuvant therapies.

Breast-conserving surgery is a widely accepted treatment option for early-stage breast cancer, but its appropriateness depends on individual factors such as tumour size, location, and patient preferences.