Ductal Carcinoma in Situ (DCIS)

Lumpectomy

Lumpectomy refers to the surgical removal of a cancerous lump (or tumor) in the breast along with a small margin of the surrounding normal breast tissue. A lumpectomy may be called a quandrantectomy when up to one fourth of the breast is surgically removed. Lumpectomy is attractive to many women because it allows them to maintain most of their breast after surgery. As stated above, the cure rate of DCIS treatment with lumpectomy is close to 100% if the margin of tissue around the tumor is cancer-free.

Not every woman is an ideal candidate for a lumpectomy. The American Cancer Society suggests that women who have already undergone radiation treatment in the breast/chest area, women with two or more areas of cancer in the same breast (requiring an additional incision to remove each), women whose previous lumpectomy did not completely remove the cancer, women with connective tissue diseases such as scleroderma (which make tissue sensitive to radiation), or women who would be pregnant at the time of radiation treatment (possibly harming the fetus) should not consider a lumpectomy as advisable treatment.

Lumpectomy may be performed to treat DCIS:

• When only one area of the breast is affected
• When the affected area is small and able to be fully removed with surgery
• If patient circumstances favor lumpectomy over more complicated surgery (mastectomy).   For instance, the patient is elderly or in poor physical health.

How is Lumpectomy Performed?

Lumpectomy is typically performed under general anesthesia. The surgeon makes a small incision over the breast lump, carefully excises (cuts free) the lump, and removes it from the breast along with at least 1 cm of surrounding tissue. A drainage tube is not usually necessary after lumpectomy as is with mastectomy. A seroma (clear fluid trapped in the wound) will usually fill the surgical cavity after the operation and naturally remold the breast’s shape. Gradually, the seroma is absorbed and the body replaces it with scar tissue. This natural healing process often prevents the appearance of a significant scar.

Patients are usually able to go home one to two days following lumpectomy, and most are able to perform normal activities within two weeks. Wound infection is not common with lumpectomy. The extent of breast soreness correlates with the amount of tissue removed during surgery. Major soreness usually ceases after two to three days. Because lumpectomy is intended to preserve the physical appearance of the breast, surgeons generally do not perform lumpectomy when over one fourth of the breast must be removed.

Radiation Therapy After Surgery

Lumpectomy (and sometimes mastectomy) usually requires six to seven weeks of radiation therapy immediately following surgery. Radiation is treatment with high-energy rays or particles used to ensure the destruction of any remaining cancer after an operation. Radiation sessions last approximately fifteen to thirty minutes after machine set-up. Patients are encouraged to wear loose-fitting clothing that can be removed easily. Patients will be instructed to lie on the treatment table under the radiation machine while radiation therapists monitor the patient from the next room on a closed-circuit television. Patients may communicate with their therapists at any time over an intercom.

Side effects of radiation therapy may include:

• swelling of the infected area
• a feeling of heaviness in the breast
• a sunburn-type appearance of skin in the affected area
• fatigue
• loss of appetite

Most of these common side effects are generally short-term, and many patients do not experience significant discomfort after their radiation treatments. Click here for more information on radiation therapy.

Mastectomy

Mastectomy is a surgical procedure involving the removal of the entire breast. Radical mastectomy involves the removal of the affected breast, the pectoral chest muscles, all chest and underarm lymph nodes, and fat and skin from the chest. If certain portions of the chest muscles are not removed, the procedure is called modified radical mastectomy.

Today, most surgeons perform simple mastectomy or recommend lumpectomy to treat DCIS. A simple mastectomy involves removing the affected breast and sometimes a small part of the underarm lymph nodes. Whenever possible, surgeons attempt to leave the overlying skin intact; or alternatively, they leave a large amount of surrounding tissue to ensure breast reconstruction.

How is Mastectomy Performed?

To perform a simple mastectomy, a surgeon makes an incision along the perimeter of the breast (closest to the tumor area), leaving most of the skin intact. Most of the time, the nipple is not removed during simple mastectomy, although milk ducts leading to the nipple are cut. The underlying tissue is gently cut free, removed, and often a drainage tube is inserted in the affected area. The skin is carefully closed with stitches or clips, which are usually removed within a week. Radiation therapy may or may not be necessary after a mastectomy.

Because mastectomy involves the removal of significantly more body tissue than a lumpectomy, recovery is slower. Patients often stay at the hospital for several days, though some are released 24 to 48 hours after surgery. The drainage tube is usually removed two to three days after the operation.

Possible effects of mastectomy include:

• wound infection
• hematoma (blood trapped in the wound)
• seroma (clear fluid trapped in the wound)
• temporary to permanent limitations of arm/shoulder movement (lymphedema) if lymph nodes are removed during the operation
• numbness in the upper-arm skin

Today, many women and their physicians are choosing lumpectomy over mastectomy to treat DCIS. Though both procedures have equal survival rates, mastectomy does carry the psychological burden of waking up without a breast (if breast reconstruction is not immediate).

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