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Breast conserving surgery (BCS) – also known as partial mastectomy, lumpectomy or wide local excision (WLE) – excises the tumour, along with a margin of healthy tissue, while preserving the rest of the breast. The aim is to remove the cancer and leave the breast looking as natural as possible. Guidelines recommend BCS as the primary surgical choice for breast cancer, 70-80% of patients should have BCS.
Breast conserving surgery is followed by radiation therapy (RT). Although there are clinical trials currently underway to investigate the omission of RT in low-risk cases, there is currently no evidence to support BCS without RT. Retrospective studies show poorer outcomes for people who omit RT after BCS (small volume DCIS may be an exception).
With modern oncoplastic surgery techniques, most cases previously considered only appropriate for mastectomy should now be offered breast conservation.
BCS may not be suitable for some patients when:
- there is multifocal/multicentric disease, extensive DCIS, or extensive malignant microcalcification that BCS cannot clear with an acceptable cosmetic result,
- radiation therapy is contraindicated (e.g. previous RT at the site, patient unable to travel to RT, severe heart or lung disease, pregnancy),
- patient has a strong preference for mastectomy (patient must be informed of the superior survival outcomes for BCS+RT over mastectomy),
- patient has a BRCA1/2 mutation.
- the ratio of tumour to breast or the location of the tumour would not allow acceptable cosmesis.
Patients with locally advanced cancer who would otherwise have required mastectomy may be eligible for BCS after neoadjuvant chemotherapy.
Male breast cancer patients usually have mastectomy rather than BCS.
Women who are in the first or second trimester of pregnancy are usually not eligible for breast-conserving surgery under current guidelines due to the need for radiation treatment.
Approximately 20% of patients require a re-excision or complete mastectomy due to inadequate margins taken in the initial BCS procedure.
