Synopsis
Choose breast-conserving surgery or mastectomy through oncological feasibility, radiotherapy implications, reconstructive options and informed patient preference rather than tumour size alone.
- Breast-conserving surgery removes the tumour with an adequate rim of tissue and preserves breast shape; it is normally paired with postoperative breast radiotherapy.
- Mastectomy removes nearly all breast tissue and is considered for extensive or multicentric disease, inability to obtain acceptable margins, contraindication to required radiotherapy, inflammatory disease or informed preference.
- A larger tumour is not an automatic mastectomy: breast size, distribution, neoadjuvant response and oncoplastic displacement or replacement can make conservation feasible.
Investigation priorities
Define all malignant foci and calcification before choosing conservation or mastectomy.
Management branches
A 46-year-old has a unifocal 22 mm cancer in a medium-sized breast and strongly prefers conservation.
- In this illustrative case, triple assessment confirms one 22 mm invasive focus with concordant imaging and pathology. There is no additional suspicious focus or diffuse calcification, the breast-to-tumour ratio is suitable and pretreatment axillary ultrasound is normal. The team confirms that complete excision with an acceptable breast shape is feasible.
- The patient receives a comparison of conservation with expected radiotherapy, possible further margin surgery, and mastectomy with reconstruction choices. She is medically suitable for either approach and can attend radiotherapy. She chooses conservation after explaining that preserving the breast does not remove the need for adjuvant treatment or eliminate distant recurrence risk.