The surgical procedure used depends on the tumor's size and location, the size of the breast and whether the patient prefers a more extensive operation (probably without radiotherapy) or feels strongly about preserving her breast with a more limited procedure. Options include:
• Removal of the tumor with a portion of the breast (lumpectomy or segmental resection) with an axillary node
dissection and radiation to the breast. The margins must be free of cancer. If they are not, there is a much
higher local failure rate. Sometimes (less than 10 percent of the time for Stages I and II) a tumor seems small,
but with microscopic study is found in multiple sites or is found to be so extensive that a mastectomy may be
needed to remove all cancer and improve the chance for cure.
• Modified radical or a total mastectomy, with removal of axillary lymph nodes . Radiotherapy is sometimes
used after a modified radical mastectomy in patients at high risk for microscopic residual tumor that could lead
to a recurrence in the area of surgery. If possible, however, the surgeon will ensure that the tissues at the edge
of the surgical incision are free of cancer cells . If radiotherapy is used, it is 90 to 95 percent effective in
eliminating these cells and preventing tumor recurrences in the skin of the chest, which is a very troublesome,
hard to manage problem that is far easier to prevent.
Removing the tumor and a portion of surrounding tissue while conserving a major part of the breast followed by radiation therapy provides a cure rate the same as the modified radical mastectomy.
