Breast conserving surgery (BCS) is fast becoming popular but one should be aware of the the contraindications of this procedure in order to avoid high recurrence rates & complications.
Breast conserving surgery in simple words is lumptectomy (removal of the tumor with a normal rim of tissue). All patients following BCS require radiotherapy. Some of the contraindications of this procedure are related to the surgical aspect whereas others are contraindications for radiotherapy.
- Pregnancy – is a contraindication for radiotherapy, as it can lead to teratogenic effects.
- Two or more primary tumors in separate quadrants (multicentric tumors). Patients with multifocal tumors (two or more primaries in the same quadrant) can undergo BCS. [Fig 1]
- Diffuse malignant-appearing calcifications on mammogram
- History of prior radiation to the breast area
- Persistent positive margins
- Inflammatory breast cancer
- History of collagen vascular disease – leads to increased radiotherapy associated complications
- Breast size to tumor size ratio [Fig 2] – Instead of the absolute size of the tumor, tumor/ breast ratio is a better indicator of whether the patient is eligible for BCS or not. Fig 2 – highlights two patients, both with identical tumor sizes but one patient has a large breast (leading to a small tumor/ breast ratio) whereas the other patient has a small breast (leading to a large tumor/ breast ratio). BCS is avoided in patients with large tumor to breast ratio as it leads to poor cosmetic outcome.
Following are NOT contraindications to BCS:
- Family history of breast cancer
- Positive lymph nodes
- Bilateral breast cancer
- Lobular histology
- Central quadrant tumor