What are the indications and management for a left partial mastectomy?

From the Guidelines

A left partial mastectomy is indicated for early-stage breast cancer, and management involves surgical excision of the tumor with a margin of healthy tissue, typically followed by whole breast radiation therapy, as recommended by the most recent guidelines 1. The procedure is performed under general anesthesia and involves making an incision over the tumor site, removing the cancerous tissue along with a rim of normal tissue (usually 1-2 cm), and possibly removing some axillary lymph nodes through sentinel lymph node biopsy or axillary lymph node dissection depending on cancer stage. Key considerations for the management of a left partial mastectomy include:

• Surgical excision with clear margins
• Whole breast radiation therapy, with a standard dose of approximately 45-50 Gy over 3-5 weeks, sometimes with a boost to the tumor bed, as supported by evidence from 1
• Adjuvant therapy based on tumor characteristics, which may include hormonal therapy, chemotherapy, and/or targeted therapy
• Recovery involves drain management if placed, incision care, pain control with acetaminophen or NSAIDs, and gradual return to normal activities over 4-6 weeks The goal of treatment is to achieve equivalent survival outcomes to mastectomy while preserving breast tissue and providing better cosmetic and psychological outcomes, as emphasized in the guidelines 1. Some patients may also be candidates for breast reconstruction, which can be discussed and planned prior to surgery, as outlined in the principles of breast reconstruction following surgery 1. It is essential to note that the decision to perform a left partial mastectomy should be based on individual patient factors, including tumor size, location, and stage, as well as patient preferences and overall health status, and should be made in consultation with a multidisciplinary team of healthcare professionals, including a surgeon, radiation oncologist, and medical oncologist, as recommended by 1 and 1.

From the Research

Indications for Left Partial Mastectomy

• The decision to undergo a left partial mastectomy is based on various factors, including tumor size, location, and patient preference 2
• Patients with early-stage breast cancer may be candidates for partial mastectomy, which aims to conserve as much breast tissue as possible while removing the cancerous tumor 3
• In some cases, partial mastectomy may be combined with other surgical techniques, such as therapeutic mammoplasty, to achieve optimal cosmetic results 4

Management of Left Partial Mastectomy

• Radiation therapy (RT) plays a crucial role in the management of breast cancer after partial mastectomy, reducing the risk of local recurrence and improving breast cancer-specific survival 5, 6
• The type and duration of RT may vary depending on individual patient factors, such as tumor size, lymph node status, and receptor status 6
• Hypofractionated RT and partial breast irradiation are alternative approaches to traditional whole breast irradiation, offering reduced treatment duration and volume of breast tissue irradiated 3
• Patients undergoing partial mastectomy may also require regional lymph node irradiation, which can be safely delivered using hypofractionated approaches 3

Surgical Techniques and Considerations

• Therapeutic mammoplasty combining partial mastectomy with nipple-areola grafting is a viable option for patients with early breast cancer, offering excellent cosmetic results and oncological safety 4
• The choice of surgical technique depends on individual patient factors, such as tumor location and breast size, and may involve amputation, inverted T mammoplasty, or L mammoplasty 4
• Symmetry procedures, such as inverted T mammoplasty on the contralateral breast, may be necessary to achieve optimal cosmetic outcomes 4