What Is Breast Conserving Surgery?

A long time ago, mastectomy or removal of the entire breast, was always used to establish local control. But now, in many cases, women can keep their breasts by careful surgery to remove all signs of breast cancer followed by radiotherapy, called "breast conserving surgery" or "lumpectomy."

Both mastectomy and breast conserving surgery have equal local control and identical survival for women with tumors 5 cm (2 inches) or less in diameter with positive or negative axillary lymph nodes, as shown by Protocol B-06 conducted by the National Surgical Adjuvant Breast and Bowel Project (NSABP).

Stanford surgeons have access to all the best and most advanced methods of diagnosing and analyzing breast cancer, and using careful surgical techniques can use lumpectomy in a large number of women, thus saving their breast.

Each woman is evaluated carefully by breast cancer surgeons to identify any and all suspicious areas in their breast so that surgery can be specially tailored to their body and treatment needs.

In some cases, women with small cancers will be given the option to participate in a (phase 2)  trial only offered at Stanford. After removal of the cancer, intraoperative radiation therapy (IORT) can be given in a specially designed operating room at Stanford Health Care.

Breast Surgery Infographic: Your Surgical Options

Surgery is generally the primary treatment for breast cancer, depending on your individual case. Techniques have been refined over the years, so there are more breast-sparing options than before. The type of surgery performed depends upon:

  • Size and location of the breast lump or tumor
  • Type and stage of the breast cancer (If the cancer has spread within the breast or has spread outside of the breast to the lymph nodes, or to other parts of the body.)
  • Size of the breast
  • Preference

Types of breast conservation surgery

Breast conservation surgery is a surgical procedure that removes the breast cancer, but not the breast itself. There are two types of breast conservation (tissue-sparing) surgery: lumpectomy and partial mastectomy.

  • Lumpectomy—removal of the breast cancer and a portion of normal tissue around the breast cancer lump to provide a buffer of normal tissue, which helps ensure the lesion has been removed completely. Radiation therapy is usually administered following a lumpectomy to destroy microscopic deposits of cancer cells that may have been in the breast tissue around the site of the main tumor.
  • Partial (segmental) mastectomy—removal of the breast cancer and a larger portion of the normal breast tissue around the breast cancer. The surgeon may also remove the lining over the chest muscles below the tumor and some of the lymph nodes under the arm.

Mastectomy

Your doctor may recommend a mastectomy (removal of the breast) as the best surgical option, depending on your circumstances. The types of mastectomies include:

Total (or simple) mastectomy

Your surgeon removes the entire breast (including the nipple, the areola, and most of the overlying skin) and may also remove some of the lymph nodes under the arm.

  • Skin-sparing mastectomy: A form of simple mastectomy which leaves intact much or all of the normal skin of the breast. This is good for smaller lesions that don't come close to the skin.
  • Nipple-areolar sparing mastectomy: A form of simple mastectomy that leaves intact much or all of the normal skin of the breast, including the nipple-areolar complex. This is a new approach, whose long-term safety has not been established.

Modified radical mastectomy

Your surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), some of the lymph nodes under the arm (also called the axillary lymph glands), and the lining over the chest muscles. In some cases, a small part of the chest wall muscles is also removed.

Radical mastectomy

(Rarely performed today) your surgeon removes the entire breast (including the nipple, the areola, and the overlying skin), the lymph nodes under the arm, also called the axillary lymph glands, and the chest muscles. A radical mastectomy is generally only recommended when the breast cancer has spread to the chest muscles.

Clinics for Breast Conserving Surgery