Conservative treatment of the breast

In which cases is conservative surgery necessary?

Conservative surgery will be offered whenever possible. Radiation therapy is almost always necessary following a lumpectomy.

The size of the tumor alone does not determine whether or not conservative treatment is feasible. It is the ratio of the tumor volume to the breast volume that determines whether treatment is feasible. The tumor must be small enough (or have become small enough after neo-adjuvant chemotherapy), in relation to the volume of the breast, to allow its removal while preserving a harmonious breast.

The lumpectomy is most often done as an outpatient surgery. If the lesion is not palpable, a localization of your tumor with a metal wire will be performed before the operation.

What is the operation for conservative treatment?

Tumor surrounded by healthy gland

Left: Tumor surrounded by healthy gland.  Right: Simple lumpectomy with scar in the areola

The surgeon removes the tumor, but also an area of healthy gland around it. In some cases, a pathological examination of the surgical specimen is performed during the operation; its purpose is to verify that there is a safety margin around the tumor. Clips are placed at the site of the tumor before resection, which will serve as a target afterwards for radiation therapy.

The lumpectomy leaves a cavity that the surgeon must fill so that the breast is not deformed. To obtain a good result, it is essential that the remodeling be done during the lumpectomy, because radiotherapy, which is systematic after conservative treatment, “freezes” the deformities and makes them more difficult to correct later.

It is possible to use plastic surgery techniques, especially in certain areas, or in the case of a tumor that is larger than the breast. When plastic surgery techniques are combined with tumor removal, it is called oncoplasty.

The scar after conservative surgery

The location of the scar must be carefully chosen according to the appearance of the breast and the size and location of the tumor. Broadly speaking, there are two types of incisions: direct incisions, in front of the tumor, and distant incisions, under the breast or around the areola.

Although the second type of surgery often appears less visible, it is not always feasible, either because it does not allow the removal of the tumor in good conditions of safety from a carcinological point of view, or because it does not allow a satisfactory remodeling of the breast.

An incision that is not very visible should neither lead to an imperfect removal of the tumor, nor to aesthetic risks.

For lumpectomies requiring oncoplasty, scars vary depending on the location of the tumor, the volume and the shape of the breast. Before the operation, the surgeon will explain to you in consultation how he or she intends to proceed. The scar and its location are less important than preserving a normal breast shape and contour. Radiotherapy, which is almost systematic in the case of cancer treated by conservative surgery, reduces the visibility of scars.