Lumpectomy, or removing the breast cancer together with a margin of healthy breast tissue, was conceived largely in response to the desire among patients to keep their breasts. Since the 1970s, clinical studies have confirmed that this option to be safe and feasible4, 5. It has to be emphasised that lumpectomy has to be paired with radiotherapy so that cure rates similar to mastectomy can be achieved.
Up till recently, women with small breast sizes with relatively large tumours were often deemed as unsuitable for lumpectomy, as such a procedure often left a large defect leading to a poor cosmetic outcome. However, 3 recent developments have enabled more women to benefit from such a surgery.
Firstly, the margins that are considered to be safe has dramatically reduced6. While early studies demanded removing a full quarter of the breast (quadrantectomy), successive studies have reduced this margin over the years. Currently, it is agreed that a microscopically clear margin is all that is needed. To achieve this, communication and coordination between the surgeon and the pathologist is of paramount importance.
Surgery is often the first treatment that a breast cancer patient goes through, with a combination of chemotherapy, hormonal therapy and/or radiotherapy given thereafter. The realisation that giving chemotherapy first, known as neoadjuvant chemotherapy, prior to surgery can result in reducing the size of the cancer7. For certain subtypes of breast cancers such as Her2 positive and triple negative tumours which are more sensitive to chemotherapy, the response can be so dramatic that the cancer has completely disappeared by the time of surgery. Hence by reversing the order of surgery and chemotherapy, we can give patients the option of keeping their breast, rather than undergoing a mastectomy if surgery was undertaken at the onset.
Finally, the emergence of new surgical techniques combining the principles of oncologic and plastic surgery has resulted in the new field of oncoplastic surgery. Careful consideration of factors, such as location of the tumour, size and shape of the breast, scar placement etc., prior to surgery results in optimal cosmetic outcome without compromising cancer clearance8. Such techniques involve filling the defect left after removing the cancer by adjacent healthy breast tissue or other nearby tissues such as fat or muscle. Another method called fat filling involves extracting fat from other parts of the body such as abdomen or thighs and injecting it into the affected breast.