The surgery of breast conservation removes the cancer while leaving the largest possible amount of breast tissue healthy, always with the aim of respecting the aesthetics of the breast.

Usually, it also removes the surrounding healthy tissue in order to obtain a negative margin (that no cancer cells remain in the breast). The breast-conserving surgery is sometimes called lumpectomy, cuadrantectomía, partial mastectomy, or segmental mastectomy, depending on the amount of tissue that is removed. It is important to know that, during the surgery, your surgeon will leave a marker at the site which was occupied by the tumor within the breast, in such a way that, when removing the cancer, we will be able to later know where the tumor was. This will also help radiation oncologists to locate the site of the cancer to radiation therapy.

WHAT YOU SHOULD KNOW BEFORE YOU UNDERGO A SURGERY TO PRESERVE THE BREAST

1. The amount of breast is removed depends on the size and location of the tumor, the size of the breast and other factors.
2. Conservative surgery allows women to keep the greater part of the breast, but it will be necessary to complete the treatment with radiotherapy.
3. Some women may also receive other treatments, such as hormone therapy or chemotherapy.
4. The choice of breast-conserving surgery with radiation therapy instead of mastectomy (surgical removal of the entire mammary gland) does not affect the odds of long-term survival. In other words, both options are equally safe and secure.
5. Not all women with breast cancer are candidates for breast-conserving surgery.
6. The side effects of the surgery can include pain, a hollow at the site where the tumor was removed, a surgical scar firm or hard.

WHO ARE CANDIDATES FOR A BREAST-CONSERVING SURGERY?

Conservative surgery is a good option for many women. The main advantage is that the woman stays with the largest part of your breast. However, you will also need radiation therapy administered by a radiation oncologist.

The women were to remove the entire breast (mastectomy) for cancers at an early stage are less likely to need radiation.

Conservation surgery of the breast can be a good option for you if:

• We will have a favorable cosmetic outcome.
• The patient is a candidate and you want to keep your breast.
• The patient is willing to receive radiation therapy and may be an appropriate follow-up (you can go to appointments).
• You have not been treated breast radiotherapy and conservative surgery previously.
• It has only one area of cancer in the breast or several areas that are close enough to remove them together without changing too much the aspect of the breast.
• You have a tumour of less than 5 cm (2 inches) and that also is small in relation to the size of the breast.
• Not pregnant, or if you are pregnant, you will not need radiation therapy immediately (to avoid the risk of damage to the fetus).
• You do not have a genetic factor, such as a mutation BRCA or ATM, that could increase their chances of having a segundocáncer breast.
• You do not have certain serious diseases of the connective tissue, such as scleroderma or lupus, you may do so especialmentesensible to the side effects of radiation therapy.
• You do not have inflammatory breast cancer
• You do not have positive margins (there were no malignant cells in the breast).
• In women with a genetic mutation, you can perform this surgery, however, in which the treatment recommended is a bilateral mastectomy.

RECOVERY OF A CONSERVATION SURGERY OF THE BREAST: WHAT TO EXPECT

Most women can go home the same day or the next day and recover quickly.

The side effects of the surgery to keep the breast may include:

• Pain or a feeling of "pull" in the chest
• Temporary swelling of the breast
• Scar tissue is hard and / or dimple that forms in the surgical site
• Change in the shape of the breast.
• Nerve pain (neuropathic) (sometimes described as burning or stabbing pain) in the chest wall, armpit or the arm that does not go away with time. This may also occur in patients with mastectomy and is called syndrome of pain posmastectomía.
• As with all operations, it is also possible to have bleeding and infection at the site of the surgery, among other complications.

DO YOU REMOVED ALL OF THE CANCER?

During the surgery, your surgeon(or) will try to remove all the cancer, in addition to a portion of normal tissue around the tumor.

After the surgery, the pathologist will examine in the laboratory the tissue that was removed. If the pathologist finds no cancer cells in any of the edges of the removed tissue, is said to have negative margins. If you are microscopic cancer cells in the edges of the tissue, is said to have margins close or positive. Having positive margins means that it is possible that some cancer cells are still in the breast after the surgery, so it is possible that the surgeon may need to go back and remove more tissue. This operation is called reescisión. If you are still cancer cells are found in the edges of the tissue removed after the second surgery, you may need a mastectomy.

SURGERY BREAST RECONSTRUCTION AFTER SURGERY OF CONSERVATION MAMMARY

The larger part of the breast removed, you will most likely notice a change in the shape of the breast after. If your breasts will look very different after the surgery, it is possible that we make some kind of reconstructive surgery or to reduce the size of the breast-healthy to make the breasts more symmetrical (uniforms). It may even be possible to do so during the initial surgery.

TREATMENT AFTER CONSERVATIVE SURGERY OF THE BREAST

All conservative surgery should be supplemented with radiation therapy to the breast after the surgery, to help reduce the chances of the cancer coming back in the same site. Sometimes, to make it easier to direct the radiation, can be placed small metal clips (that will show up in x-rays) within the breast during surgery, to mark the area. Many women will receive hormonal therapy (in case of breast cancer, hormone-dependent) after the surgery to help reduce the risk of the cancer coming back. Some women may also need chemotherapy after surgery. If so, radiotherapy, and hormonal therapy is usually delayed until you complete the chemotherapy.