The principle of the surgical management of breast cancer is to remove all disease and ensure there is also normal breast tissue excised that surrounds the cancer that is removed. This is called the margin and where this is achieved, we refer to this as a clear margin. This is essential to allow us to conclude that all the breast cancer has been safely removed. Depending on the size and location of the cancer but also the proportion of the total amount of breast tissue that requires removal will largely determine what operation is recommended. There are further contributing factors to this recommendation and there always remains a choice where more than one operation will be effective.
The two options are broadly speaking breast conserving surgery (lumpectomy) or mastectomy (removal of all the breast tissue). Plastic techniques can be used to allow for larger breast cancers to be removed with a lumpectomy whilst reshaping the breast to avoid a defect. These techniques will generally uplift the breast, a little like a breast reduction and as breast tissue is removed will make the breast a little smaller. If this change of volume and shape is significant, patients will also be offered the option of symmetry surgery to the other breast for matching.
If you are offered a mastectomy for the surgical treatment of breast cancer you will also be entitled to have a conversation about reconstruction options which can be done at the same time. Some options or even immediate reconstruction itself may not be appropriate or recommended for you but the reasoning and rationale for this will be discussed.