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

Updated: Feb 13, 2019
  • Author: Mary Jo Wright, MD; Chief Editor: James Neal Long, MD, FACS  more...
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Answer

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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