What is breast conserving surgery?
This surgery is done to remove breast cancer and save the breast. During surgery, a “rim” of what looks like normal tissue around the cancer is removed. This is called the margin. Ask your surgeon if this is an option for you. The other option is a mastectomy (complete removal of the breast). You and your surgeon should discuss:
The cancer size compared to your breast size.
Is the cancer in a single spot in the breast or are there many lesions?
Your choice to save the breast.
Can you have radiation therapy after the surgery?
Do you have an “inflammatory breast cancer?”
In most cases, the survival rate is the same between breast conserving surgery and mastectomy. This is a personal choice. It is based on your values and needs. Some people want to save their breast while others want a shorter surgery and to recover faster. With breast conserving surgery, you recover quicker. Your options also depend on if surgery is needed for the lymph nodes.
There may be a slightly higher risk of the cancer coming back after breast conserving surgery. Negative margins can lower this risk. Radiation treatment to the breast is important, as it can lower the risk of the cancer returning.
What if my margins still show cancer after the surgery?
Some cancers may grow into what looks like normal tissue. These cancer cells cannot be felt or seen on x-rays. They cannot be seen by the naked eye. A pathologist will look at this tissue under a microscope. Most times, you will have the results of your surgery within a week. If cancer is seen at the edge of the margin, it is called a “positive” margin. This may increase the risk of the cancer coming back in the breast. Your surgeon may want to take out more tissue at a second surgery. This is called a re-excision surgery. This can occur in up to 1 out of 5 persons. Some patients have “close” margins. Your doctor may wish to do a re-excision surgery in this case as well. This ensures there is no cancer left in the breast.
Why is radiation used?
Radiation lowers your risk of the cancer coming back in the breast. With radiation, the risk that cancer comes back is low, about 5-10%. Without radiation, the risk that the cancer comes back in the “conserved” breast can be as high as 30-40%. Radiation is advised for most women; however, there are times it is not. Talk to your doctor. Radiation can be given in different ways and over different periods of time.
What are the side effects of radiation?
The most common side effects are local reactions (like a sunburn) and feeling tired. The local reaction will fade. Most people can work while they get radiation. The treatments can be scheduled around your work times. If you wish, you may meet with a radiation oncologist before your breast conserving surgery. This can help you learn more about radiation and may help you make your decision about surgery.
What will my breast look like?
The goal is to keep the shape of the breast and prevent “dents.” There will be a scar.
Your breast may be smaller or the nipple slightly moved to one side. The size and place of the cancer affects this. Talk to your surgeon so you know what to expect.
What can I expect the day of surgery?
You may be seen in different places the day before or the day of surgery. We will make sure you know where to go. On the day of surgery, someone will help you get to all the places that you need to be.
You may have a wire localization or radioactive seed placement procedure before surgery. See Health Facts for You #8160 – Breast Localization Before Surgery.
You may have a sentinel lymph node biopsy done at the same time. See Health Facts for You #7733 – Sentinel Lymph Node Mapping and Excision of Sentinel Node(s). For this, you get an injection of tracer material. This helps the surgeon find the lymph nodes. This may be done the day before or the morning of surgery. If you get the injection the morning of surgery, the staff at the surgery center will schedule this for you.
If you choose a paravertebral block for anesthesia, this is done in the surgery center. See Health Facts for You, #7154 - Anesthesia for Breast Surgery for more information.
The surgery itself takes about 1 hour. If a you need a sentinel node biopsy, it may take 1 ½ to 2 hours. Once the cancer tissue is removed, the surgeon closes the incision with sutures. Some sutures dissolve on their own, while others are removed at a later visit. You can expect to go home within a few hours of surgery. Someone must drive you home and stay with you the night of your surgery.
You will have a follow-up visit with your surgeon in 1-2 weeks. Most people can go back to their normal activities; but, you should avoid strenuous activities. We suggest you take off work for 1-2 weeks. You may go back to work sooner if you feel well and your job allows. Check in with clinic staff if you have any questions.
Care of Your Breast Incision
You may have a gauze bandage over the site. This can be removed after 24 hours. If you have drainage from your incision, place a new piece of gauze over the site.
Your incision is either covered with special tape called Steri-Strips or sterile super glue. The gauze bandage covers this area. The steri-strips are often removed at your follow up visit. If they fall off sooner, it is ok.
Look at the site daily for any problems or signs of infection. You may see a slight redness and swelling along your incision. This is normal.
You may shower 24 hours after surgery. Let the water flow over the incision(s). Pat dry. Do not soak in a tub or pool until you are seen by your surgeon at your follow-up visit.
What is a seroma and how do I know if I have one?
A seroma is a fluid-filled bulge that forms under the skin in the area of surgery. Some women may hear a “sloshing” sound in the breast when they move. This is fluid filling the surgical area. If you develop a small seroma, your body will slowly absorb this over time. If you have a seroma that is getting larger and causing pain, please contact your doctor. This is not an emergency. You may be asked to return to the clinic to have the fluid drained.
What to Know About Pain and Narcotics
The amount of pain that women have after surgery varies. You will get a prescription for narcotic pain medicine.
Use them as needed and as ordered.
Do not drive while taking narcotics.
If you have nausea, take your pain medicine with food.
Narcotics can cause constipation.
Eat plenty of fiber (bran, oats, fruits and vegetables).
Drink 6-8 glasses of water a day.
Take stool softeners if needed.
Most women find that taking 1–2 tablets of Extra-Strength Tylenol® every 4-6 hours helps to relieve pain. You may take up to a total of 8 tablets in a 24-hour period. Do not take more. If you have liver disease, check with your doctor first. You may also take ibuprofen as directed by your doctor. Talk to your doctor if you take other pain medicine. You may use ice from time to time on the incision site. Do not use a heating pad. This this may cause a burn to the skin.
When to Call
Please call us if you have:
Rapid increase in swelling.
Firmness or bruising.
An opening in the incision.
Sudden increase in pain.
Drainage from your incision which is more than a few drops on the gauze.
Fever of 100.4°F (38°C) or greater taken by mouth 2 times, 4 hours apart.
Important Phone Numbers
To reach your doctor Monday – Friday, 8:00 am to 5:00 pm:
UW Health Breast Center at UW Hospital (608) 266-6400 or toll-free 1-800-323-8942
UW Health Surgery Clinic at 1 South Park St. (608) 287-2100 or toll-free 1-888-703-2778
UW Hospital Emergency Room (608) 262-2398
Meriter Hospital Emergency Room (608) 417-6206
Your local Emergency Room
UW Health Breast Center at UW Hospital – Call UW Hospital Paging at (608) 262-0486 and ask for the surgery resident on call. Give your name and phone number with the area code. The doctor will call you back.
UW Health Surgery Clinic at 1 South Park St. – Call (608) 287-2100 and ask for the doctor on call. Give your name and phone number with the area code. The doctor will call you back.