Breast Conserving Surgery and Adjunct Treatment for Breast Cancer
by Kyle B. Potts, MD, FACS

In this article I would like to review some of the ways we, as surgeons specializing in breast cancer surgery, can aid our patients in breast conservation. Breast conservation is simply using techniques confirmed by evidence based science and research that limits the amount of breast or lymphatic tissue removed during surgery as well as biopsy techniques.

Breast cancer diagnosis- In the past, this required an open breast biopsy to diagnose breast cancer or to differentiate between benign and malignant tumors. Today we have image guided, minimally invasive procedures including stereotactic core biopsy often performed in a radiology center or ultrasound (us) guided core biopsy, mainly for solid tumors, that we can perform right in our office. This allows a diagnosis and further treatment planning without taking the patient to the operating room.

Surgical removal of breast cancers or lumpectomy- The surgical treatment of breast cancer has changed significantly over the last several years. Since prospective randomized studies performed in the late 70’s and early 80’s, it has been known that under certain circumstances, namely stage 1 and stage 2 breast cancer, local therapy consisting of lumpectomy (removal of the breast cancer and a free margin of at least 1 mm) along with radiation therapy is equivalent to mastectomy alone with regard to breast cancer recurrence, disease free survival and long term survival. It has been since this study that surgeons specializing in breast cancer surgery have made significant strides in conserving breast tissue in women with early stage breast cancer when possible.

Sentinel lymph node biopsy- at one time completely removing the lymphatic tissue during the performance of the mastectomy or lumpectomy was standard of care. We can now often limit our sample to a few of the main lymph nodes or “sentinel” nodes that drain the breast and if cancer has spread beyond the breast in the lymphatic’s, these lymph nodes are the most likely to contain cancer cells. This can help in the staging and limit the amount of lymphatic tissue removed and therefore the inherent risk of performing a complete axillary lymph node dissection which can include nerve damage, arm pain and severe lymphedema.

Partial breast irradiation- Radiation therapy is an important part of breast treatment after lumpectomy for breast cancer. The standard of care remains external beam radiotherapy in which the whole breast and portions of the chest wall are externally treated. However, an evolving form of treatment is partial breast irradiation. A special catheter is implanted in the lumpectomy cavity either during the initial surgery or, at a later time, usually in the surgeon’s office under us guidance. This is used to locally irradiate the site of the prior cancer, the advantage being less radiation to the rest of the breast and chest wall. Therapy is twice a day for five days versus daily for six weeks. All current studies indicate equivalence in treatment, recurrence rate and better cosmetic results. Keep in mind, this is a newer therapy and recommended usage is limited to a narrow patient population. Current studies are underway to evaluate this type of treatment in a broader set of patients.

The diagnosis of breast cancer can be overwhelming. For those women who have this diagnosis it can be a great relief to find that newer treatments are available which can help preserve breast tissue with similar treatment results and excellent cosmetic outcomes.

Remember, the best way to treat breast cancer is to find it early. Always perform monthly self breast exams, obtain yearly clinical breast exams by your physician and, for women over 40 years of age, yearly mammograms prove invaluable.