Breast-Conserving Surgery Patients at Washington Hospital Have Low Rates of Repeat Surgeries

Removing a Tiny Amount of Extra Tissue Around Margins Can Minimize Need for Additional Surgery Later

Breast-conserving surgery – also known as lumpectomy or partial mastectomy – is among the most common cancer surgeries performed in the United States. According to a study published in 2012 in the Journal of the American Medical Association (JAMA), an estimated 60 to 75 percent of breast cancer patients undergo lumpectomy or partial mastectomy as their initial treatment.

“Physicians have been performing breast-conserving surgery on breast cancer patients for decades,” says surgeon Dr. William Dugoni, medical director of the Washington Women’s Center. “In breast-conserving surgery, we remove the cancerous area and a surrounding margin of normal tissue. The goal is to take just enough tissue so that the breast looks as normal as possible after the surgery while the chance of the cancer coming back is low. Radiation therapy is usually given after surgery for several weeks. For early-stage breast cancer, breast-conserving surgery combined with radiation therapy has the same survival rate as mastectomy.”

Unfortunately, the authors of the study published in JAMA noted that breast-conserving procedures often require additional surgery (re-excision) if the margins around the tumor contain cancer cells.

“Our results demonstrate an overall re-excision rate of 22.9 percent that is lower than previous studies demonstrating re-excision rates of 36 to 50 percent,” the authors state. “(Another study) reported a re-excision rate following initial breast-conserving therapy of 37.9 percent … with 26 percent undergoing partial breast re-excision alone and 11.9 percent ultimately undergoing mastectomy.”

In 2012, the year that study was published in JAMA, the rate for Washington Hospital patients undergoing partial breast re-excision alone was 10 percent, and the overall re-excision rate (including those undergoing mastectomy) was 13 percent. In both 2014 and 2015, Washington Hospital reported rates of 3 percent for patients undergoing partial breast re-excision alone and 10 percent for the overall re-excision rate (including those undergoing mastectomy).

Dr. Dugoni credits both scientific thinking and surgical artistry for the large difference between the nationally reported rates of re-excision and the rates at Washington Hospital.

“I had become frustrated by the reports that one out of four women nationally had to go back for re-excision after breast-conserving surgery,” he explains. “These additional surgeries can cause significant emotional, physical and economic stress for patients. When you have to go back into the breast to take out more volume after the breast has already started to heal, the cosmetic result is not as satisfactory. Plus, the need for additional surgery has the potential to delay the use of other treatments, including radiation therapy.

“So we developed a surgical procedure to take a little more tissue around the edges of the margins during initial surgery,” he continues. “I call it the ‘orange peel’ procedure, taking a tiny bit more of the ‘rind’ around the cavity. In my opinion, that is the ‘true margin’ of the tumor. The volume of the extra tissue we remove is significantly less than we would have to take out during a re-excision procedure, and the result is much more satisfactory from a cosmetic standpoint. With 25 years of experience, I have been able to fine-tune the surgical techniques, and it requires a certain amount of artistry. We strive for negative margins, but we don’t want to take out too much.”

Not all breast cancer patients are candidates for breast-conserving surgery, Dr. Dugoni cautions.

“Women who are in the early stage of pregnancy cannot undergo radiation therapy, so they are not good candidates for breast-conserving surgery,” he says. “Breast-conserving surgery also is not a good option for women who have multiple tumors clumped in one part of the breast or scattered throughout the breast. Likewise, breast-conserving surgery would not work well for women with a prior history of radiation treatment to the chest or breast, or for those with a high genetic risk for breast cancer.

“Sometimes it’s just a matter of personal choice,” he adds. “Some women opt to have a total mastectomy rather than breast-conserving surgery. My ultimate goal is to protect my patients – physically, emotionally and financially. I want to provide them with the best possible treatment for their particular circumstances.”

Learn More

Washington Women’s Center offers advanced diagnostic services as well as numerous wellness and support programs for local women. Accredited by the National Accreditation Program for Breast Centers, Washington Women’s Center is committed to providing the best possible care to patients with diseases of the breast. For more information, visit www.whhs.com and click on “Women’s Center” under the “Services” tab at the top of the home page.

If you need help finding a physician, visit www.whhs.com and click on “Find Your Physician.”