Breast Conservation Surgery

What is breast conservation surgery?

Breast conservation surgery may be referred to as a lumpectomy or a wide local excision. Breast conservation surgery is the removal of a breast cancer or other breast lesion with a small margin of normal breast tissue surrounding it. Breast conservation surgery leaves the majority of the breast in place. Many breast cancers in Australia are diagnosed whilst they are very small and often unable to be felt. Small cancers such as these are suitable for breast conservation surgery. 

Why do I have to have radiotherapy with breast conservation surgery for breast cancer?

Breast conservation surgery was designed to avoid the need for mastectomy for the treatment of small breast cancers. Instead of removing the entire breast, only the cancer is removed with a small margin of normal breast tissue around it. Studies have shown that the remaining breast tissue is at a high risk of developing a cancer within it if left untreated. Breast radiotherapy treats the remaining breast tissue after breast conservation surgery to decrease the chance of developing a cancer recurrence.

The long-term results of breast conservation surgery with breast radiotherapy are comparable to having a mastectomy. On average the 5-year risk of your breast cancer recurring with breast conservation surgery and radiotherapy (approx 5-7%) is only slightly higher than having a mastectomy (approx 2-5%) whilst maintaining a good cosmetic result.

Breast conservation surgery alone without radiotherapy may result in a high chance of the breast cancer recurring (approx 15-25%). Therefore when selecting breast conservation surgery for breast cancer, you need to be able and willing to undergo breast radiotherapy.

Why might I need a re-excision to get a bigger margin?

Breast conservation surgery aims to remove the breast cancer with a small margin of normal breast tissue around it. The final pathology result will tell us the extent of the margin. The result will either be described as adequately cleared, close or involved. A close or involved margin, means that there is cancer close to or right at the area where the lump of breast tissue was removed. An involved margin nearly always requires another operation to take additional tissue. A close margin may require re-excision however each case is individual and will be discussed with you.

If after a few attempts to obtain clear margins there is still cancer present at the margin or if the tumour turns out to be much larger than expected on mammogram or ultrasound, a mastectomy may be recommended. 

What is a hookwire?

Many breast cancers are detected on screening mammograms without any breast lump felt. In these circumstances, a wire is used to locate the cancer within the breast. This wire is called a hookwire and is placed into the breast on the morning of your operation in the radiology department. The hookwire allows the surgeon to locate the tumour and remove it at surgery.