Introduction
It is a surgical method that has recently been widely used for breast cancer. Removing the cancerous area and some healthy tissue around it while leaving a large section of the breast in place is called breast-conserving surgery (BCS, MKA).
Removing only the cancerous area and the tissue around it. :The technique of the method is similar to the technique used in the wire-guided biopsy method. This method is also called lampectomy, tumorectomy or tilectomy in medical language. The most critical aspect of this method is the adequate and appropriate removal of intact tissue around the cancer. However, it cannot be said that there is a clear consensus on how much normal breast tissue should be removed.
In general, it is stated that removing cancer-free normal tissue with a thickness of at least 2 mm along with the tumor may be sufficient. However, it is difficult to determine this thickness during surgery, and the exact amount of this thickness can only be determined by marking and examining the removed tissue by the pathologist. If, as a result of this examination, the thickness of non-cancerous healthy tissue in any part of the removed part is less than 2 mm, re-surgery may be considered.
This surgery is quite difficult. In order to overcome this difficulty to some extent, the directions both on the removed part and where the cancer was removed are marked with metal clips to understand which part of the part has been inadequately processed and the surgery is planned accordingly. In addition, this marking will be a guide for subsequent radiation treatment. In order to avoid these negativities mentioned above, in our practice, we try to keep the tissue thickness other than cancer at least 1-2cm during surgery.
A; Achieving firmness in the skin incision and removing the firmness along with the surrounding area. B; Placement of marker clips (red color) on the removed part and in place of the hardness in the breast.
Removal of one quarter of the breast: As mentioned before, a breast is relatively divided into 4 separate quadrants, each containing approximately one quarter of the breast. Located at or near the center of a quadrant In case of established cancer, that quadrant is removed. This surgery is called quadrantectomy (Figure 1). In this surgery, which is performed on the condition that the decision is made according to the location of the cancer, its diameter and the size of the breast, more breast tissue is removed than just the cancerous area.
Figure 1: Removal of the lower outer quadrant of the breast (quadrant B).
Although breast-conserving surgery seems to be an ideal method and has found application in many breast cancers, some It is not recommended in such cases. These situations are given below.
In which cases breast-conserving surgeries may not be appropriate?
Breast cancers that are not in the early stage: In short, the presence of cancer only in the breast or limited spread to the armpit. Breast cancer that has not spread to other areas is called early-stage breast cancer and usually includes stage I and stage II cancers. If the cancer found in the patient does not have these characteristics, it would not be rational to perform breast-conserving surgery.
Single-focal cancer covering a large area in the breast: This condition is called widespread tumor, and since there is a high probability of cancer tissue remaining after breast-conserving surgery, this method is not recommended. .
Cancer in more than one area of one breast: In this case, the fact that the cancer is at an early stage loses its importance. In other words, these patients are not ideal candidates for breast-conserving surgery. Sometimes cancers in two different areas may be close to each other, and both cancers can be removed through a single incision without causing too much breast tissue loss. The point to be considered in these cases is that there is no suspicious formation in other parts of the breast.
The cancer is under the area around the nipple (areola area): In this case, the nipple and its surroundings It is difficult to remove cancer with safe and secure boundaries by protecting it. However, the nipple and the area around it can be removed and the nipple and areola can be reconstructed (G quadrant and surrounding area). On the other hand, the general preference is to remove the breast.
The breast is small: In this case, the shape of the breast left behind after conservative surgery may be distorted and the cosmetic appearance may not be good.
The diameter of the cancer is large. : blood If the breast diameter is large (greater than 5cm), a large amount of breast tissue will need to be removed, and the problem encountered in small breasts will also be encountered here. Sometimes, although the cancer is large in size, with additional preoperative treatment (neoadjuvant chemotherapy) and/or neoadjuvant radiotherapy, the cancer size can be reduced and preventive surgery can be performed in these patients. However, if the size of the cancer does not decrease with this treatment, it would not be realistic to recommend preventive surgery.
Breast cancers in pregnant women: As mentioned above, it is a rule to give radiation therapy to the patient after breast-conserving surgery. However, radiation therapy cannot be given to pregnant women because the risk of causing various problems, including developmental abnormalities, in the unborn baby is very high. Therefore, breast-conserving surgery should not be performed on pregnant women.
Patients who have previously received radiation therapy to the same breast: Breast-conserving surgery is considered not suitable in this group.
Women with potentially serious connective tissue disease: Breast-conserving surgery is not recommended in these patients due to the possibility of side effects of radiation therapy after breast-conserving surgery.
Breast-conserving surgery is not recommended in these patients. gene (BRCA gene) mutation: It is important to detect a mutation in the breast cancer gene (BRCA gene) along with breast cancer, especially in young patients. Performing breast-conserving surgery on these patients is not very popular. Because, even if radiation therapy is given, the probability of recurrence of cancer in the remaining breast tissue is higher than in those without cancer gene mutation.
Other: In some cases, it may be found that the cancer is borderline in the piece examined after breast-conserving surgery. In this case, surgery is considered again and some more solid tissue is removed from around the removed area. If this attempt fails, breast-conserving surgery should not be insisted on and other methods should be applied.
Read: 0
