What You Need To Know About Breast Conservation Surgery

Breast-conserving surgery (BCS) is a part of a treatment plan for breast cancer. It is also known as lumpectomy or a partial mastectomy.

Breast-conserving surgery (BCS) removes cancer cells while leaving as much normal breasts as possible. Some surrounding healthy tissue and lymph nodes are removed during the surgery. Depending on how much tissue is removed, breast-conserving surgery is sometimes called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. 

Advantages of breast-conserving surgery (BCS)

Breast-conserving surgery (BCS) is an excellent option to treat cancer in its early stage. The main advantage is that you can keep most of your breasts. However, you will also need radiation therapy. You are less likely to need radiation if your entire breast is removed (mastectomy) for early-stage cancers. But you may be referred to a radiation oncologist for evaluation because each patient’s cancer is unique.

Need for breast-conserving surgery

BCS is done as part of treatment for breast cancer. If you have a small lump and are only in one area then this surgery is the best option. BCS removes a minor part of your breast. BCS works just as well as surgery to remove the entire breast (mastectomy), thus reducing the chances of cancer cells returning. Studies show that women who underwent BCS followed by radiation therapy have the same long-term survival rates as women who have a mastectomy.

Risks of breast-conserving surgery

All surgeries have some risk. Some possible complications of BCS include:

1. Swelling in the breast.
2. Change in the shape and size of the breast.
3. Stiffness due to scar tissue that may form at the cut site.
4. Infection in the wound.
5. Swelling of the arm after removal of lymph nodes.
6. A clear fluid (seroma) is often found in the wound after BCS. If needed, this can be drained in the surgeon’s office and treated with compression.
7. There may be other risks depending on your medical condition. If you have any concerns, discuss with your doctor before the surgery.

Your doctor may not recommend a lumpectomy for breast cancer in case:

• You have a history of scleroderma, a group of diseases that harden the skin and other tissues and make healing after lumpectomy difficult.
• Because you have a history of systemic lupus erythematosus, a chronic inflammatory disease that can worsen if you undergo radiation treatments.
• You have two or more tumors in different quadrants of your breast that cannot be removed with a single incision, which could affect the appearance of your breast.
• Since you have previously had radiation treatment to the breast region, which would make further radiation treatments too risky.
• You have cancer that has spread throughout your breast and overlying skin since a lumpectomy would be unlikely to eradicate cancer.
• You have a large tumor and small breasts, which may cause poor cosmetic results.
• Don’t have access to radiation therapy.

Reconstructive surgery after breast-conserving surgery

Reconstruction surgery is done after breast-conserving surgery to give your breast a natural look. Depending on how much of the breast is removed, it may look different afterwards. Sometimes, reconstructive surgery may be an option, or it may be possible to make your other breast smaller to look both breasts alike. The surgeon may even do this during the BCS.

Breast-conserving surgery procedure

 BCS is done on an outpatient basis. You can go home the same day. Procedures may change depending on your condition and your doctor’s practices. BCS is generally done under local anesthesia. You will get medicine for sedation in your IV before the procedure. It will help you relax. You will likely stay awake but feel sleepy during the surgery.

A small cut is made over or near the breast tumor to remove the lump or abnormality. The doctor may remove some of the normal breast tissue around it for safety.

A separate surgical cut is made in or near the armpit to remove lymph nodes under your armpit. Breast tissue and other removed tissues are sent to the lab for an examination. A drainage tube is inserted into the affected area. Then the skin is closed with stitches or adhesive strips. 

Taking care of arm after lymph node removal

Removing lymph nodes during BCS may affect how lymphatic fluid drains from your arm. Problems with lymphatic drainage may cause swelling in your arm. You may also be at risk for infection from injury to your arm. And there is a higher risk of blood clots in your armpit veins after surgery.

You will have to follow specific safety steps for the rest of your life after removing the lymph node. This will help control problems in the affected arm. These safety steps include:

• No needle sticks or IVs were placed in the affected arm.
• Don’t measure blood pressure in the affected arm.
• Follow instructions about arm exercises carefully.
• Avoid injuries, such as scratches or splinters, to the affected arm.
• Raise the arm with your hand above your elbow to help drain lymphatic fluid.
• Put on gloves while gardening or doing any activity. It may increase the risk of getting a cut on your fingers or hands. Also, wear gloves while taking strong or harsh chemicals, such as detergents or household cleaners.
• Avoid sunburns as much as possible. 
• Use a clean razor to shave your underarm.
• Don’t wear tight items like elastic cuffs, tight watches, or other jewelry on the affected arm.
• Use your good arm or both arms to carry heavy packages, bags, or purses.
• Avoid insect bites or stings. Use insect repellents or wear long sleeves.

Recovery from breast-conserving surgery

You can start functioning after going home and often return to regular activities within two weeks. Sometimes, you may need help at home, depending on how extensive your surgery was.