When is lumpectomy contraindicated in the surgical treatment of breast cancer?

Answer

Relative contraindications to lumpectomy include small breast size, large tumor size (>5 cm), and collagen vascular disease. Absolute contraindications include the following:

Multifocal disease
History of previous radiation therapy to the area of treatment
Inability to undergo radiation therapy for invasive disease
First or second trimester of pregnancy
Persistent positive margins following attempts at conservation

Factors that are often considered but should not be deterrents include axillary node involvement and tumor location. Consideration of cosmesis, while important, should never outweigh the clinical priority of obtaining negative surgical margins. For instance, lesions involving Paget disease of the nipple may be treated with excision of the nipple-areolar complex and reconstruction. Larger lesions in patients with concerns regarding cosmesis may be better served by standard modified radical mastectomy and concurrent reconstruction.

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Media Gallery

This mammogram shows a spiculated mass to be transfixed by the guidewire
Grid technique of localization.
This orthogonal (mediolateral) projection confirms the position of the needle to be placed beyond the cluster of microcalcification.
This specimen radiograph shows the wire and the localized speculated mass in situ, with a good excision margin.
Radical mastectomy defect.
Inflammatory breast cancer.
Advanced breast cancer.
Metastatic breast cancer to the back.
Nipple retraction due to breast cancer.
Breast cancer. Lobular carcinoma in situ. Enlargement and expansion of lobule with monotonous population of neoplastic cells.
Breast cancer. Lobular carcinoma in situ. Enlargement and expansion of lobule with monotonous population of neoplastic cells.
Breast cancer. Infiltrating ductal carcinoma. Low-grade carcinoma with well-developed glands invading the fibrous stroma.
Breast cancer. Intraductal carcinoma, comedo type. Distended duct with intact basement membrane and central tumor necrosis.
Breast cancer. Intraductal carcinoma, noncomedo type. Distended duct with intact basement membrane, micropapillary, and early cribriform growth pattern.
Breast cancer. Papillary carcinoma. Solid papillary growth pattern with early cribriform and well-developed thin papillary fronds.
Breast cancer. Inflammatory carcinoma. Nests of tumor cells plugging dermal lymphatics.
Breast cancer. Colloid (mucinous) carcinoma. Nests of tumor cells in pool of extracellular mucin.
Breast cancer. Estrogen receptor, immunostain. Positive staining of tumor cell nuclei with monoclonal antibody to estrogen receptor.
Breast cancer. Her-2/neu overexpression. Infiltrating carcinoma with strong membrane immunoreactivity representing Her-2/neu overexpression.

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Author

Mary Jo Wright, MD Associate Professor of Surgery, Chief of Breast Surgery Service, Tulane University School of Medicine; Medical Director, Breast Cancer Center, Medical Center of Louisiana, New Orleans

Mary Jo Wright, MD is a member of the following medical societies: American Association for the Surgery of Trauma, American College of Surgeons, American College of Surgeons, Association for Academic Surgery, Association for Surgical Education, Society of Critical Care Medicine, Society of Surgical Oncology, Eastern Association for the Surgery of Trauma, Association of Women Surgeons, Orleans Parish Medical Society, American Society of Breast Surgeons, American Society of Breast Disease

Disclosure: Nothing to disclose.

Coauthor(s)

Krzysztof Moroz, MD Professor of Pathology, Director of Cytopathology

Krzysztof Moroz, MD is a member of the following medical societies: American Society for Clinical Pathology, United States and Canadian Academy of Pathology, American Society of Cytopathology, College of American Pathologists

Disclosure: Nothing to disclose.

Chief Editor

James Neal Long, MD, FACS Founder of Magnolia Plastic Surgery; Former Associate Professor of Plastic and Reconstructive Surgery, Division of Plastic Surgery, Children's Hospital and Kirklin Clinics, University of Alabama at Birmingham School of Medicine; Section Chief of Plastic, Reconstructive, Hand, and Microsurgery, Birmingham Veterans Affairs Medical Center

James Neal Long, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American College of Surgeons, American Medical Association, American Society of Plastic Surgeons, Plastic Surgery Research Council, Sigma Xi, Southeastern Society of Plastic and Reconstructive Surgeons, Southeastern Surgical Congress

Disclosure: Nothing to disclose.

Acknowledgements

R Edward Newsome, Jr, MD† Program Director and Chief, Associate Professor, Department of Surgery, Section of Plastic Surgery, Tulane University Health Sciences Center

Disclosure: Nothing to disclose.

Diane M Opatt, MD Clinical Instructor of Surgery, Temple University School of Medicine; Assistant Program Director, Department of Surgery, Abington Memorial Hospital

Disclosure: Nothing to disclose.

Christian Paletta, MD, FACS Professor, Division Chief and Program Director, Department of Plastic and Reconstructive Surgery, St Louis University School of Medicine

Christian Paletta, MD, FACS is a member of the following medical societies: Alpha Omega Alpha, American Association of Plastic Surgeons, American Burn Association, American Cleft Palate/Craniofacial Association, American College of Surgeons, American Medical Association, and Missouri State Medical Association

Disclosure: Nothing to disclose.

Christina Reed, MD Staff Physician, Department of General Surgery, Tulane University Health Sciences Center

Disclosure: Nothing to disclose.

Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Medscape Salary Employment

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