What is breast conserving surgery?

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The conservative surgery technique revolutionized the history of mastology. The main objective, in addition to adequate oncological control, is the maintenance of body aesthetics. Breast-conserving surgery is complete removal of the malignant tumor, with free surgical margins (no residual disease) and dissection of the axillary sentinel lymph node. Currently, oncoplasty techniques are used to promote better aesthetic results.

It is recommended to place metal clips on the surgical margins to guide future radiotherapy, as well as to allow adequate radiological follow-up

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                                                        breast conserving surgery

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                                          Oncoplasty incisions according to tumor location

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Correction of the contralateral breast is sometimes necessary to promote good symmetrization. The lipofilling technique or fat grafting can be used to correct any asymmetries.

Whenever breast-conserving surgery is performed, radiotherapy of the breast field is associated in the postoperative period. Scientific studies have shown an overall disease-free survival equivalent between mastectomy and breast-conserving surgery.

There are situations in which, even in initial cases, mastectomy (complete removal of the breast) is indicated, such as:

● multicentric disease;

● tumor size in relation to the small breast;

● Presence of malignant-appearing diffuse calcifications;

● Previous history of chest radiotherapy (eg, mantle radiation for Hodgkin's disease);

● Persistently positive margins despite attempts at re-excisions.

For patients who desire conservative surgery, but who are not candidates at the time of presentation, an alternative approach is the use of neoadjuvant therapy, which can allow for the reduction or even disappearance of the tumor, enabling the preservation of the breast, without compromising the results of survival.