What are the contraindications for breast conservation in breast cancer

There are certain contraindications to breast-conserving surgery for breast cancer, including large tumors, multifocal lesions, and inability to receive radiotherapy during pregnancy. The key lies in the patient's willingness. Even if it is technically feasible, it is a contraindication if the patient is unwilling to conserve the breast.

1. Tumor size and location

The size of the tumor directly affects the feasibility of breast-conserving surgery. Generally speaking, patients with larger tumors, especially those larger than 5 cm, have more difficult breast-conserving surgery because the surgery may not be able to completely remove the lesion, leaving a risk of recurrence. The location of the tumor is also critical. If the tumor is located in the center of the breast or close to the nipple, the surgery may affect the appearance and function of the breast.

2. Multifocal lesions

Multifocal breast cancer refers to multiple independent cancer foci in the same breast. In this case, it is difficult to ensure that all cancerous tissues are removed completely during breast-conserving surgery, which increases the risk of postoperative recurrence. Multifocal lesions are generally considered a contraindication for breast-conserving surgery.

3. During pregnancy

Pregnant patients are usually unable to receive radiotherapy, which is one of the essential treatment steps after breast-conserving surgery to kill residual cancer cells and reduce the risk of recurrence. Radiotherapy during pregnancy may cause harm to the fetus, and pregnancy is considered one of the contraindications to breast-conserving surgery.

4. The patient’s personal wishes

What cannot be ignored is the patient's personal wishes. Some patients may not want to undergo breast-conserving surgery for psychological, cultural or other personal reasons. In this case, even if breast conservation is technically possible, the patient's choice should be respected. Doctor-patient communication is particularly important here. The doctor needs to fully understand the patient's thoughts and provide comprehensive information to help the patient make a decision.

5. Other health conditions

The patient's overall health will also affect the choice of surgical option. For example, patients with severe heart disease or other major medical conditions may not be able to withstand the burden of surgery and postoperative care. In this case, the doctor may recommend other treatment options.

6. Adaptability of postoperative radiotherapy

Breast-conserving surgery is usually followed by radiation therapy to reduce the risk of recurrence. If a patient cannot undergo radiation therapy for various reasons, such as radiation allergy or physical condition, then breast-conserving surgery may not be suitable.

When considering breast-conserving surgery, it is very important to comprehensively evaluate the patient's condition, personal wishes, and health status. The doctor and the patient need to discuss together, weigh the pros and cons, and choose the most appropriate treatment plan. In this way, the patient's personalized needs can be met to the greatest extent while ensuring the treatment effect.