Dr Felicia Tan, breast surgeon at Mount Elizabeth Hospitals, sheds light on breast conserving surgery, a surgical option for patients in treating breast cancer.
There is good long-term evidence to show that a lumpectomy (also known as breast conservation surgery) followed by radiotherapy has equivalent survival outcomes to mastectomy (breast removal surgery) for early breast cancer.
For women with more advanced breast cancer, chemotherapy or hormonal therapy can be administered prior to surgery to shrink the tumour and allow for a lumpectomy to be performed. Lumpectomies may also be performed to remove certain non-cancerous and pre-cancerous breast abnormalities.
What is a lumpectomy?
A lumpectomy involves the removal of the breast tumour together with a rim of normal breast tissue that surrounds it.
The goal of lumpectomy is to remove the tumour while at the same time maintaining the normal appearance of the breast.
This procedure is usually performed under general anaesthesia. If the breast abnormality cannot be felt but is detected on mammogram and ultrasound, a radioisotope marker or thin wire may has to be inserted prior to surgery to mark and locate the area to be removed. Precise localisation of the tumour is key to performing this procedure and minimising the amount of breast tissue that needs to be cut out.
What are the risks?
The main risk of lumpectomy is an incomplete removal of the breast tumour. If the tumour is incompletely excised, a repeat surgery may be required to remove more tissue.
Lumpectomies should only be performed by trained breast surgeons as a poorly performed surgery could lead to unacceptable cosmetic deformities of the breast.
Who is suitable for lumpectomy?
Lumpectomy is one of the many options to treat breast cancer but not everyone is a suitable candidate.
For example, patients with multiple areas of tumour in the breast would do better with a mastectomy. Patients whose cancer has involved the nipple would have a better cosmetic outcome with a mastectomy followed by reconstruction.
Lumpectomy is not advised for patients with conditions that that do not allow radiotherapy treatment (eg. patients who have undergone previous radiation to the same area). Lumpectomy is also not suitable if the patient opts against radiotherapy.
Article contributed by Dr Felicia Tan, general surgeon at Mount Elizabeth Hospital
Fisher, B., Anderson, S., Bryant, J., Margolese, R.G., Deutsch, M., Fisher, E.R., Jeong, J.H., Wolmark, N. (2002, October 17) Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. New English Journal of Medicine, 347(16):1233-41. DOI: 10.1056/NEJMoa022152