Questions about Breast-Sparing Surgery with Radiation

If I choose breast-sparing surgery, how much of my breast has to be taken out?

In a lumpectomy the surgeon removes the cancer and a small amount of surrounding normal tissue but leaves most of the breast intact. With other types of breast-sparing surgery, somewhat larger areas of the healthy breast are removed. This distance between the outer edge of the tumor and outer edge of the normal tissue surrounding it is known as the margin. The goal of breast-sparing surgery is to obtain clear, or clean, margins — that is, a band of normal breast tissue around the entire tumor that is completely free of cancer. This dictates how much breast is ultimately removed.

Will breast-sparing surgery affect the look of my breast & What will the scar look like?

How the breast looks after surgery will depend on the size of the cancer compared to the size of the breast and the amount of healthy breast tissue that is removed. The appearance of the scar depends on the type of surgery and the location of the cancer. Your doctor can give you an idea of how breast-sparing surgery may affect the look of your breast. If your doctor says that breast-sparing surgery is an option for you, then he or she expects that the cancer plus a margin of normal tissue can be removed with a good cosmetic outcome.

Will I still have feeling in my breast after breast-sparing surgery?

Most women who have breast-sparing surgery followed by radiation therapy will still have sensation in the breast.

What does radiation therapy after breast-sparing surgery involve?

Radiation therapy is usually performed as an outpatient procedure over a period of at least 5 weeks. Some women are not able to make that commitment. Some women live far from radiation facilities or can't afford to take the time for daily treatments. Others may have health conditions such as pregnancy, lupus, or heart disease, that prevent them from undergoing radiation. Since radiation therapy lowers the risk of recurrence for women who choose breast-sparing surgery, patients and their doctors must consider the requirements for radiation therapy before deciding which surgical option is best for them.

Why do I need radiation therapy if the tumor is removed with clear margins?

Women who have radiation therapy after breast-sparing surgery are less likely to have cancer come back in the same breast than women who have breast-sparing surgery without radiation.

What are the chances of the cancer coming back if I have breast-sparing surgery with radiation? If I decide on a breast-sparing surgery with radiation, how can you be sure there are no other "spots" in the breast?

Most women who have breast-sparing surgery followed by radiation will not have cancer recur in the same breast. In studies, recurrence rates within 10 years of breast-sparing surgery followed by radiation range from 4 percent to 20 percent. This might seem like a big range. But keep in mind that cancer that recurs in the same breast can be treated and does not affect chances of a healthy recovery compared to mastectomy. Another thing to keep in mind is that doctors suggest breast-sparing surgery only if they feel it offers a very good chance of removing all of the cancer. Obtaining a clear margin is one way the surgeon can lower the risk of recurrence. Radiation also lowers the risk of the cancer recurring in the same breast.

What are the side effects of breast-sparing surgery? What about the side effects of radiation? I hear it makes the breast hard.

When considering what kind of surgery to have, it is important to know that there are potential side effects common to all surgical procedures. Any surgical procedure carries a risk of infection, poor wound healing, bleeding, or a reaction to the anesthesia. Also, pain and tenderness in the affected area is common, usually only in the short term. Because nerves may be injured or cut during surgery, most women will experience numbness and tingling in the chest, underarm, shoulder, and/or upper arm. Women who undergo breast-sparing surgery usually find these changes in sensation improve over 1 or 2 years, but they may never go away completely.

Radiation therapy can cause side effects, such as fatigue or skin irritation. These side effects tend to be mild. Radiation therapy can cause a skin condition that looks like sunburn. This usually fades, but in some women it never goes away completely. Some women do find that radiation makes their breast feel hard or firm. Again, this may last just a few months, or longer.

Removal of lymph nodes under the arms may be performed. This can lead to pain and arm swelling, called lymphedema, which can last a long time and be debilitating.

Keep in mind that the side effects of treatment vary for each person. Some women may have many side effects or complications, others may have very few. Pain medication, physical therapy, and other strategies can help women manage side effects and recovery.

I heard that radiation can cause cancer. Will it increase my risk for other cancers?

Radiation therapy has improved greatly through the years, and the doses are much lower than they used to be. The risk of another cancer due to radiation therapy to the breast is very small. The bottom line is that women who have radiation therapy after breast-sparing surgery are less likely to have cancer recur in the same breast, and they live just as long as women who undergo mastectomy without radiation.

If cancer recurs in the same breast after having breast-sparing surgery followed by radiation, will I need a mastectomy then? Will I be able to have breast reconstruction even though I have had radiation?

Cancer that recurs in the same breast usually is removed with surgery. Most often a mastectomy is performed at that time, because radiation is not recommended a second time. Breast reconstruction is possible after previous radiation therapy, but the surgery may be harder to perform. This issue should be discussed with a plastic surgeon.