Breast saving surgery for breast cancer and the future improvements


Breast cancer is one of the most common/dominant types of cancer in the Netherlands. Due mammographic screening and the alertness of women, early recognition is possible. This is very important for the prognosis, and the cosmetic result. Nowadays 75 percent of the breast cancer patients can have a breast saving surgery in combination with radiotherapy because of early recognition1. The 10-years surviving of patient with breast cancer found in an early stage is 90 percent, irrespective of the sentinel lymph node status2, 3. The sentinel lymph node is the hypothetical first lymph node where the cancer will drain in to. Cancer in this sentinel lymph node means more risk of metastasizing of the cancer cells to the rest of the body and a bad prognosis. 
Using the breast saving therapy in combination with radiotherapy the cosmetic result is much better compared to mastectomy. When mastectomy is used the whole breast and his lymph's will be removed, whereas the breast saving therapy only removes the cancer and the fewest healthy breast as possible. The problem is that the breast saving therapy not always results in great cosmetic results. The reason of this bad result is due the following factors; the location of the tumor, postoperative complications, amount of tissue removed and the use of boost during radiotherapy. If a breast saving therapy is used the minimum tissue that should be removed around the tumor is 1mm. In reality this is not so easy. Surgeons use a margin of 0,5 to 1cm to prevent the remaining of tumor.
If more then 85cm3 of breast tissue is removed the cosmetic result will be poor, irrespective of the size of the breast. The margin of 1mm and the usage of 1cm implies that improvement in this technique is possible.




1. Inspectie voor de gezondheidszorg. Basisset prestatie indicatoren 2011. Utrecht; 2011.
2. Nederlandse Kankerregistratie (NKR); cijfers, overleving; borst. 6e editie; 2003-2007
3. Giuliano AE, et al. Axillary dissection vs no axillary dissection in women with invasive breast cancer and sentinal node metastasis: a randomized clinical trial. JAMA. 2011;305:569-75