Incision location for lumpectomy

My incision was an arc along the outer edge of the areola.  The scar is minimal and fades into the areola.  If they can do it, that probably leaves the best result in appearance.  My tumor was near the nipple so that incision was close to the tumor. 

The breast consists of a number of separate branching structures that converge on the nipple.  When they are doing a lumpectomy I think they usually remove the whole branching structure that contains the tumor even if the tumor is small and only in one location, because there is always the possibility of stray cancer cells having traveled through the ducts within that branching structure.  That should mean they can use the areola incision approach regardless of whether the tumor is near to or far from the nipple. 

The surgeon will try to balance taking out enough tissue for good margins vs. keeping the amount low enough to leave a good appearance.  Especially with DCIS s/he cannot tell for sure how wide the margins are until after the pathologist examines the tissue.  DCIS does not all show up visually or on imaging.  The surgeon is using test results and experience to try to get the right balance on margins. 

The size of the margins is related to recurrence risk but there is no magic number.  Almost everyone agrees that less than 2 mm is too small and the risk of cancer remaining beyond the margin is too great.  Some would say 3 mm.  When people talk about ideal margins being 10 mm they are talking about taking a wide area around the tumor site.  The area right around the tumor site is at highest risk of recurrence.  If they can get 10 mm margins it may then be reasonable to consider skipping radiation therapy.  The area of the breast beyond the 10 mm margins still has some recurrence risk but it is lower than that of the tumor site.  The possibility of getting 10 mm margins depends on breast size.  For small breasted women that may not leave much of a breast.  For large breasted women that may mean the discrepancy in breast size makes breast reduction on the other side desirable. 

You can get different opinions but most would agree:

a. margins less than 2-3 mm are not good enough

b. margins of at least 2-3 mm are good enough assuming you have radiation therapy

c. margins of at least 10 mm might be enough to consider skipping radiation (if you have only DCIS but it still depends on other factors)

Scorp 1111,

location of incision!! Thanks for asking your question, because it forced me to go back and look for where I saw this mentioned. My DCIS was at 10 o'clock but closer to the nipple than yours - a Timex vs Big Ben?? Anyway, my incision is at the edge of the aerola, like you are describing. Therefore,  when I read remarks about this type of incision in one of the abstracts placed on-line as part of the NIH Consensus Conference on DCIS in Sept 09 - I took note. Since you were diagnosed relatively recently you might not know about the conference or the wealth of info on  DCIS it makes available to you. The conference is actually on-line, but more reasonably than listening to three days of doctors blabbing - there are abstracts and a final paper to read. http://consensus.nih.gov/2009/dcis.htm   . The abstracts are available by clicking pdf next to the word abstract in the upper left. Anyway, on page 61 of the abstracts, in her paper "Local Control of DCIS Based on Tumor and Patient Characteristics,  Lisa Newman, MD mentions " A long dissection tunnel from the skin to the site risks exposure of normal tissue to cancer cells."  She goes on to say how this type of incision might cause problems if there is a need for re-excision. In my case, I hope my DCIS was close enough to the aerola so that a "dissection tunnel" was not created -  in any event, I then received radiation and a boost. In retrospect, however, if the creation of a dissection tunnel to achieve a cosmetically pleasing result had been discussed with me, I would have said No thanks. 

Note that you have been diagnosed with DCIS and Krissy with Stage 1. Krissy had nodes biopsied while that is not the norm when a lumpectomy is performed for DCIS. Hope your re-excision goes well Krissy!  and good luck to you Scorp 1111 

Julie E

Bumping this up because this was my question about my DCIS surgery. My DCIS was found waaaaay in the back near the chest well and the BS made the incision around the areola. I'm happy if the reason for is for reduced scarring. The core needle biopsy went in from the side and after 6 weeks, I still have a hematoma left over which I wonder if it will ever be absorbed.