There are several types of surgical approaches differentiated by the level of invasiveness and the anatomical structures preserved post-operatively. Modified radical mastectomy, simple mastectomy, skin-sparing mastectomy, nipple-areolar sparing mastectomy, and lumpectomy w/ axillary lymph node dissection are most often utilized in practice.
Lumpectomy is the removal of the suspicious lesion without the removal of the whole breast, therefore not requiring reconstruction. It is used to remove both invasive (invasive ductal, lobular) and non-invasive cancers (DCIS, LCIS) of the breast. Lumpectomy is often performed with sentinel lymph node biopsy to assess for nodal metastasis. When combined with adjuvant radiation treatment, as is commonly practiced, lumpectomy is termed breast-conserving therapy. If patients are candidates, breast-conserving therapy is preferred to mastectomy due to the similar rates of overall survival1 and favorable cosmetic outcomes. Studies are increasingly showing better overall survival with breast-conserving therapy when compared to mastectomy without radiation.2
Breast-conserving surgery is considered the treatment of choice for non-metastatic breast cancer when the tumor can be removed with negative margins and a favorable cosmetic outcome. If patients are not willing to undergo or have a contraindication to adjuvant radiation treatment, they may not be candidates for breast-conserving therapy.
Breast-conserving therapy begins with the surgical removal of the primary tumor (lumpectomy). Pre-operatively, radiology may place wires defining the lesion to aid the surgeon with localization in the OR. An incision is made directly superficial to the lesion or placed circumareolar, within the inframammary fold, or along the lateral contour of the breast to improve cosmesis and allow the best access to the tumor. Regardless of the location, the incision should follow Langer’s lines. The tumor is excised and oriented for pathological evaluation with a stitch or ink to ensure negative margins. The defect is closed cosmetically.
Attention is now turned to the sentinel lymph node dissection. With a radiotracer probe, the sentinel node is identified, removed, and sent for pathology.
General surgical risks:
Risks specific to lumpectomy: