Indication:
An operation done to remove the breast cancer but not the breast itself is called Breast conserving surgery (BCS). It is also called Breast sparing surgery. Most commonly the surgery will be followed by radiation therapy to the remaining breast. This consolidated treatment is called breast conservative therapy (BCT). The main indications for BCT are (3)
Considered optimal therapy for early Breast Cancer
Stage I or Stage II Breast Cancer (localized tumour)
- Tumour not fixed to overlying skin or underlying muscle
- Negative surgical margins
- No diffuse, inflammatory or multicentric cancer
- No malignant appearing mammographic abnormalities after surgery
- Lymph node not be fixed to other lymph nodes or to the surrounding tissue
Invasive ductal and lobular cancer not contraindication provided the tumour is not diffuse and negative surgical margins are achieved
The contraindications for BCT are (3)
a) Absolute
- Two or more primary tumors in different quadrants
- Associated diffuse suspicious microcalcifications
- Previous Breast irradiation
- Pregnancy (unless near estimated delivery date)
b) Relative (due to resulting cosmetic result)
- Collagen vascular disease (poor vascular supply)
- Large tumour in small Breast
Treatments:
Types of breast-conserving surgery include (1) a. Lumpectomy -Removal of the tumour with a small amount of surrounding normal tissue
b. Quadrantectomy -removal of one quarter, or quadrant, of the breast
c. Segmental mastectomy -removal of the cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumour.
Depending on the tumour size and location, the type of surgery will be planned by your doctor. The surgery will be done on a day care basis where over night stay is usually not required. You will be given general anaesthesia, that is medicines to go asleep and you will not feel the pain of surgery also. For this you will be instructed not to take orally for about 8 hours before the planned surgery. During surgery, a small cut is made on your affected breast skin and the tumour along with little surrounding breast tissue will be removed. If lymph nodes are also planned for removal, they will be done through a separate cut in the skin. After the procedure, the skin will be closed with self absorbable sutures and dressing will be placed over it. If necessary a tube may be placed at the surgery site to drain the contents getting collected there. (4)
The tissue removed during the surgery will be sent for further microscopic examination, to a pathologist. Usually after the procedure you will be able to go home on the same day but rarely you will need to stay in the hospital for a day or two.
The surgery will be followed by radiation therapy which will start 2-4 weeks after the surgery. You will have to take the radiation therapy approximately for 5 days a week for 6 weeks. (3)
Cosmetic results are good to excellent after breast conserving therapy that is the treated and untreated breast are almost identical or there are only slight differences. The effects of BCT on the appearance of the breast take about three years to stabilize. Factors such as weight gain and the normal age-related sagging of breast tissue also affect the shape and size of the breasts.
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Self-care instructions:
Do's and Don'ts after breast conserving surgery:
- Inform your doctor if you are on any medications before the surgery and confirm what you can continue after the surgery
- Also inform your doctor if you are expecting pregnancy so that care can be taken before prescribing medications
- Take the prescribed medicines regularly
- Keep the surgical area and the dressings clean and dry
- If drain was placed, then empty its contents at regular intervals and also keep it clean.
- Care of the arm on the side of surgery is very important especially if lymph nodes were removed under your arms to prevent occurrence of swelling of arm called lymphedema.
- Never allow any one to give injections or draw blood from the arm on the side of surgery.
- Do not allow measuring of blood pressure on the side of surgery.
- Avoid wearing any tight garments, jewellery, watches or elastic cuffs to the arm on the side of surgery.
- Elevate the arm, with the hand above the elbow, to assist drainage of lymphatic fluid
- Start simple exercises of the arm which your doctor has instructed
Common things to expect at home:
Normal activities may be resumed within 2 weeks.
- You may have mild pain depending on the amount of tissue removed
- You may feel soreness at the site. Take the prescribed pain relievers for pain as well as soreness.
- There may be slight numbness, tightness or tingling sensation at the surgery site on the breast or under your arms.
- Seroma is normally seen after a BCS. But if it is troublesome, it can be drained in a surgeon's office and treated with a compression or an injection that helps to harden the space in the breast if necessary.
- Bleeding
- Pain
- Infection
- Collection of fluid (Seroma)
- Temporary swelling of the breast
- Breast disfigurement (size and shape)
- Hardness due to scar tissue that can form at the site of the incision
- Wound infection or bleeding
- Lymphedema or swelling of the arm due to lymph node removal. This is preceded by early symptoms, which include a feeling of tightness in the arm, pain, redness, and decreased flexibility of the arm, hand, and wrist.
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Schedule for Consultations/Diagnostic tests:
You need to visit your doctor after 7 days of surgery for wound review and general check up. You will also receive your histopathology reports during this visit. Depending on the report your further line of treatment will be advised by your doctor.
If drain was placed during the surgery, your doctor will ask you to come for follow up once the volume of the drain contents have come down. After examining the drain and its contents, it will be removed.
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