Listen to your body. Be Aware.



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What are the components of a Breast Conserving Surgery (BCS)?

Breast Conservation Surgery includes the following two procedures:

What are the prerequisites for a Breast Conserving Surgery (BCS)?

For a patient to undergo BCS, certain conditions need to be fulfilled. They are as follows:

In which instances can a Breast Conserving Surgery (BCS) not be done?

The answer very well lies in the above points.

  • Multicentric Disease: As explained above, if the disease in the breast lies in two or more separate areas or quadrants, a BCS cannot be done.

  • Patient not ready for post operative radiation therapy Post operative radiation therapy is an integral component of BCS and if any patient is unwilling to undergo a radiation therapy, then a BCS cannot be done.

  • Why is post operative Radiation Therapy (RT) a must for any patient undergoing a BCS?

    Cancer of the breast arises due to 'induced' genetic changes in the glandular and ductal cells of the breast, whatever be the 'inducing' agent, be it the female hormone estrogen, or be it anything else. These changes may be in a single cell, which ultimately replicate and form the tumour; or may be a part of a more generalized process, where all the cells have some form of changes which may ultimately culminate into a cancer. In a BCS, we remove the tumour with a surrounding normal margin of about 1 cm of so. But even ensuring a margin of 1 cm, what is the guarantee that no more cancer cells are remaining behind? And also, there will definitely be some chances atleast, that since a cancer has arisen in that breast, it can do so again from the remaining cells in that breast.

    It was seen that if a wide excision lumpectomy was done, and if post operative rasiation therapy was not given, the chances of a cancer coming back in that breast were in the range of almost 25% to 40%, which is definitely very high and unacceptable. For this purpose, post operative radiation therapy was evaluated and it was found that after a post operative radiation therapy, the chances of recurrence come down to a mere 3% to 10%. Hence, post operative radiation therapy is an integral component of a BCS.

    Can a Breast Conserving Surgery (BCS) be done for large tumours?

    When the size of a tumour is large (but still operable), and the size of the breast is not relatively large, then BCS is a problem, since it will result in an unacceptable cosmetic result. In this situation, a Neo Adjuvant Chemo Therapy (NACT), can be given, which will reduce the size of the tumour, and then a BCS may be feasible. A majority of patients respond very well to NACT and will ultimately become feasible for BCS. If the size of the tumour doesn't shrink with NACT and the patient still desires breast conservation, then she must be counselled about other forms of reconstruction.

    After a Breast Conserving Surgery (BCS), what is the risk of cancer coming back in the same breast?

    After a BCS with post operative radiotherapy, the chances of a 'local recurrence', meaning the chances of disease coming back in the same breast range from 3% to 14%. Though these chances of local recurrence are more than in a mastectomy, they do not affect the overall survival. So one should not be worried about this fact, and not go for mastectomy, just because chances of disease coming back are slightly higher.