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What is breast conserving surgery?

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












                                                        breast conserving surgery





                                          Oncoplasty incisions according to tumor location

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.


What is sentinel lymph node?

It is the first draining lymph node in the armpit. In early tumors, the analysis of the lymph node closest to the tumor, called sentinel lymph node, is performed. If he is free of the disease, the other axillary nodes are probably too.

  Preoperatively, a dye and/or a radioactive substance is injected, which will allow the location of this first draining lymph node in the breast. This ganglion is examined by the pathologist and, if it is free of neoplasia, dissection of the other axillary ganglia is dispensed with

  Patients with one or two involved sentinel nodes do not need a complete axillary dissection. However, if three or more sentinel nodes are positive, an axillary lymph node dissection should be performed. All other tumor risk factors and the patient's performance status and comorbidities need to be taken into account.












                                                 Sentinel lymph node with dye injection

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Sorocaba Medical Center


Rua Sorocaba, 464 - room 202

Tel. 21 2537-0138 / 2539-5093

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Americas Medical City

Barra da Tijuca

Av. Jorge Curi, 550 - rooms 252/253

Tel. 21 3264-4866 / 3264-4863

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