Definition & Overview
A partial mastectomy is a surgical procedure used as part of breast cancer treatment. It is called a breast-conserving surgery because it removes only the cancerous tissue and a margin of healthy tissue around it. It is a less invasive alternative to a complete mastectomy, which removes the entire breast. Breast-conserving surgery, in general, is the preferred treatment method for early-stage breast cancer.
The goal of a partial mastectomy is to remove the entire malignant tumour while maintaining the normal appearance of the breast. The surgery effectively reduces the risk of recurrence but does not cure cancer unless combined with other cancer treatment methods.
Who Should Undergo and Expected Results
A partial mastectomy is for patients who suffer from breast cancer. It is only used for malignant growths. The surgery to remove a benign growth in the breast is called an excisional breast biopsy.
The goals of a partial mastectomy are to:
- Remove as much cancerous tissue as possible while conserving the normal appearance of the breast
- Relieve the patient’s symptoms
- Remove a margin of healthy tissue around the tumour to help prevent recurrences
- Restore or reconstruct the breast’s normal appearance
- Determine whether cancer has spread to the lymph nodes
How much of the breast is removed during a partial mastectomy depends on the following factors:
- Tumour size
- The location of the tumour
- The number of tumours in the breast
- Breast size
- What percentage of the breast is affected
- Family history of breast cancer
- General health
A partial mastectomy is usually combined with other cancer treatments. Each patient will have a unique treatment plan depending on the severity of their condition and other factors. However, most patients suffering from early-stage breast cancer benefit from a partial mastectomy combined with radiation therapy. On the other hand, patients who undergo a complete mastectomy during the early stage of cancer may no longer need radiation therapy.
As for the appearance of the breast after a partial mastectomy, studies show that up to 75% of patients were happy with the results of the procedure. Twelve percent of patients rated their breast appearance as “fair” while only 13% found it to be poor.
How is the Procedure Performed?
There are many kinds of partial mastectomies, which are used based on the tumour’s location. These include:
- Lumpectomy – This is a general term that refers to a procedure used to remove a lump in the breast, instead of the entire breast. It is also called a tylectomy.
- Quadrantectomy – This removes a quarter (or a quadrant) of the breast tissue as well as a large part of the overlying skin and the underlying fascia. Its goal is to remove the tumour as well as up to 2-3 centimetres of normal tissue around it. This type of surgery is also called segmentectomy or segmental mastectomy.
- Nipple saving mastectomy – This type of mastectomy uses special techniques to remove breast tumours while preserving the nipple. It causes much less scarring and skin trauma compared to a traditional mastectomy, which completely removes the nipple. By saving the nipple and natural breast skin, it is easier to reconstruct the breasts with the use of implants.
The following steps are taken to perform a partial mastectomy:
- The patient is placed under general or local anaesthesia.
- The surgeon makes a small cut on the breast.
- Once the surgeon gains access to the tumour, he removes all cancerous tissue as well as some normal tissue surrounding it.
- The surgeon may also remove the lymph nodes in the armpit. This may be done during the same procedure. However, this is only needed if cancer has already spread to the patient’s lymph nodes.
- The surgeon will close the cut with sutures, making sure that the breast looks as normal as possible.
- In some cases, a drain is attached to the breast. The drain usually stays in place for as long as two weeks. It is used to drain out any fluid discharge from the surgical wound. The drain needs to be emptied a couple of times every day.
The removed tissue is sent to a pathologist for analysis. If the edges of the removed tissue are non-malignant, it is called a “clear margin”. If the cancerous tissue is too close to the edge of the removed tissue, more tissue may have to be removed. This means the patient will need another surgery.
A partial mastectomy takes around an hour, and patients can go home on the same day. The recovery period is also quite short. Most patients can resume their normal activities after a week.
The incision may take about a month to fully heal. While the wound is healing, the patient has to regularly change the dressing to prevent infection.
Possible Risks and Complications
Patients who undergo a partial mastectomy are at risk of:
Signs of a possible infection include:
- Pus discharge
As with all surgeries performed under anaesthesia, partial mastectomy also puts patients at risk of:
- Allergic reaction due to the anaesthesia
At the end of the procedure, the surgeon will try his best to make the breast look as normal as possible. However, there is a possibility that the following will occur:
- Uneven sizes of the two breasts
Numbness around the incision site
Veronesi U, Saccozzi R, Del Vechhio M, Banfi A, Clemente C, et al. “Comparing radical mastectomy with quadrantectomy, axillary dissection, and radiotherapy in patients with small cancers of the breast.” N Engl J Med 1981; 205:6-11. http://www.nejm.org/doi/full/10.1056/NEJM198107023050102
Bassiouny M, El-Marakby HH, et al. “Quadrantectomy and nipple saving mastectomy in treatment of early breast cancer: feasibility and aesthetic results of adjunctive latissmus dorsi breast reconstruction.” J Egypt Natl Canc Inst. 2005 Sep;17(3):149-57. http://www.ncbi.nlm.nih.gov/pubmed/16799652