Lumpectomy (Partial Mastectomy)

Abstract

Indications • Invasive breast cancer with tumor small enough relative to the breast to allow resection with negative margins and acceptable cosmesis • Localized ductal carcinoma in situ and pleo-morphic lobular carcinoma in situ (similar relative size considerations apply) • No contraindications to postoperative radiation therapy (if indicated as part of the planned treatment of the cancer or in situ lesion) Essential Steps 1. Mark palpable lesion preoperatively. Ultrasound can be used as an adjunct to improve precision of marking. If not palpable , localize with preoperative stereotactic or ultrasound-guided wire placement. 2. General anesthesia. 3. Prep and drape the involved breast. 4. If palpable mass: (a) Circumlinear/radial incision over mass with local anesthetic prior to incision. (b) Develop flaps. Flap thickness should depend on the depth of the lesion. (c) Resect palpable mass with margins intact. Extend resection to include the pectoralis fascia if appropriate. (d) Orient the specimen. (e) Send for pathology. (f) Identify that no additional masses are palpable. (g) Consider taking additional margins if close on palpation on original specimen. 5. If needle-localized lumpectomy: (a) Review localizing radiography and estimate trajectory of the wire, location of wire tip, and mass. (b) Circumlinear/radial incision over the estimated location of the target lesion with local anesthetic prior to incision. (c) Develop flaps. (d) Deliver wire into operative field. (e) Resect tissue around wire, including mass and appropriate margins. (f) Orient the specimen. (g) Send to radiology for confirmation of complete lesion resection and removal of the localizing clip, if one is present. (h) Re-excision of margins if margins are close on radiology. (i) Send for pathology.