Making Informed Choices: Breast Conservation Surgery (BCS) vs. Mastectomy in Early Breast Cancer

Dr. Gaurav Goel, Consultant Surgical Oncologist, HCG Cancer Centre, Jaipur

Breast cancer is a growing concern worldwide, and India is no exception to this trend. With increased screening and awareness, more cases are being diagnosed at earlier stages. This has led to a shift in the standard of care, where Breast Conservation Surgery (BCS) has emerged as a viable option for women with early breast cancer. In the past, mastectomy, the complete removal of the breast, was often the only surgical choice, causing psychological trauma and a sense of loss. However, BCS offers a ray of hope with its less invasive nature, shorter recovery time, and improved psychological outcomes.

 What is Breast Conservation Surgery (BCS)?

Breast Conservation Surgery, as the name suggests, aims to conserve as much of the breast tissue as possible while removing the cancerous area with safe margins. This procedure ensures an acceptable cosmetic outcome and is associated with fewer complications and better psychological recovery compared to mastectomy. After BCS, patients may also require axillary dissection and radiotherapy, which significantly reduces the risk of tumor recurrence.

Many women are suitable candidates for BCS if they are motivated to preserve their breast, and if the disease is confined to one area or quadrant of the breast. However, there are some contraindications, such as pregnancy or connective tissue disorders, that may exclude certain individuals from this option. Additionally, regular hospital visits for follow-up are necessary to monitor progress.

 Dealing with Large Breast Tumors

Even if you have a large breast tumor, BCS can still be a possibility. Neo-adjuvant treatments, such as chemotherapy or targeted therapy, can help shrink the tumor, making it feasible to opt for BCS over mastectomy.

 The Role of Intra-Operative Frozen Section Analysis

One of the primary concerns with BCS is whether the entire tumor is removed during surgery. Advances in pathology and the use of intra-operative frozen section analysis allow us to ensure complete tumor removal during the procedure itself, alleviating these concerns.

 Ensuring Cosmesis after BCS

Preserving the aesthetic appearance of the breast is crucial. Oncoplastic Breast Surgery, or oncoplasty, offers techniques for the restoration of breast shape, size, and symmetrical cosmetic outcomes. This can be achieved through volume replacement and displacement techniques, helping women feel confident and satisfied with the results.

 Treatment Following BCS

After undergoing BCS, radiation therapy becomes a critical requirement. During surgery, the tumor area is marked with metal clips to facilitate precise radiation treatment. Depending on the specific case, other treatments like chemotherapy, targeted therapy, or hormone therapy may also be necessary.

 Choosing Between BCS and Mastectomy

The choice between BCS and mastectomy can be emotionally challenging. Many women and their families may believe that mastectomy is the safer option, as it removes the entire breast. However, numerous studies conducted over a decade or more have shown no difference in survival rates between mastectomy and BCS with radiotherapy. In fact, BCS with radiotherapy is considered as effective as mastectomy, offering women the opportunity to preserve their breast while ensuring their health and well-being.

In conclusion, Breast Conservation Surgery has become the standard of care for early breast cancer, offering women a chance to conserve their breast and maintain their quality of life. With advances in surgical techniques, pathology, and adjuvant treatments, BCS is a viable and effective option that empowers women to make informed choices about their breast cancer treatment.