Surgery

Quadrantectomy or Lumpectomy: Conservative treatments of the breast

Quadrantectomy and Lumpectomy have become the standard treatments for small tumours or, in some cases, after a course of primary (neo-adjuvant) chemotherapy.

The Milan study (later confirmed by US studies), first published in 1981, and after 20 years of follow-up, confirms that there is no
difference in the survival rate between the patient group treated with quadrantectomy/lumpectomy and axillary dissection followed
by radiation therapy and the patient group treated with radical mastectomy according to Halsted.

«Skin sparing mastectomy» (SSM) and «skin and nipple sparing mastectomy» (SNM)

Despite the significant increase in conservative surgery treatments, mastectomy remains the most appropriate treatment for large or multicentric tumours, in case of recurrence or medium-sized tumours in small-volume breasts. In about 25% of cases, mastectomy remains the treatment of choice.

«Skin sparing mastectomy» (SSM) may be proposed in some cases. Sparing the skin improves breast reconstruction quality by producing less visible scars and maintaining a more natural breast shape. The nipple-areola complex (NAC) is often excised because of the higher risk of recurrence when it is conserved.

However, the nipple-areola complex is very important for the appearance and identification of the breast and its removal is often experienced as a mutilation.

In some selected cases, its conservation may be proposed through «Skin and nipple sparing mastectomy» (SNM), which is sometimes associated with intraoperative radiotherapy (IORT).