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Shedding Light on Breast Conservation Surgery

Shedding Light on Breast Conservation Surgery

The diagnosis of breast cancer does not equate to losing one’s breast. There is good long-term evidence to show that a lumpectomy (also known as wide excision or breast conservation surgery) followed by radiotherapy has equivalent survival outcomes as mastectomy 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.

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.

Lumpectomy as an option to treat breast cancer

Figure 2

Figure 2. Radioisotope Occult Lesion Localisation (ROLL)

This procedure is usually performed under general anaesthesia. If the breast abnormality cannot be felt but was detected on mammogram and ultrasound, a radioisotope marker or thin wire may have 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 to minimise the amount of normal breast tissue that needs to be excised.

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.

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 in which the cancer has involved the nipple would have a better cosmetic outcome with a mastectomy with reconstruction. Lumpectomy is also not encouraged in conditions that preclude radiotherapy treatment (ie. previous radiation to the same area; certain diseases like systemic lupus erythematosus and scleroderma) or if the patient opts against radiotherapy.


Article contributed by Dr Felicia Tan, General and Breast Surgeon, Mount Elizabeth Hospital.


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