Quadrantectomy Health Article

Definition

Quadrantectomy is a surgical procedure in which a "quadrant" (approximately one-fourth) of the breast, including tissue surrounding a cancerous tumor, is removed. It is also called a partial or segmental mastectomy.

Purpose

Quadrantectomy is a type of breast-conserving surgery used as a treatment for breast cancer. Prior to the advent of breast-conserving surgeries, total mastectomy (complete removal of the breast) was considered the standard surgical treatment for breast cancer. Procedures such as quadrantectomy and lumpectomy (removing the tissue directly surrounding the tumor) have allowed doctors to treat cancer without sacrificing the entire affected breast.

Demographics

The American Cancer Society estimates that approximately 211,300 new cases of breast cancer are diagnosed annually in the United States, and 39,800 women die as a result of the disease. Approximately one in eight women will develop breast cancer at some point in her life. The risk of developing breast cancer increases with age: women ages 30–40 have a one in 252 chance, ages 40–50 a one in 68 chance, ages 50–60 a one in 35 chance, and ages 60–70 a one in 27 chance.

In the 1990s, the incidence of breast cancer was higher among Caucasian women (113.1 cases per 100,000 women) than African American women (100.3 per 100,000). The death rate associated with breast cancer, however, was higher among African American women (29.6 per 100,000) than Caucasian women (22.2 per 100,000). Rates were lower among Hispanic women (14.2 per 100,000), American Indian women (12.0), and Asian women (11.2 per 100,000).

Description

The patient is usually placed under general anesthesia for the duration of the procedure. In some instances, a local anesthetic may be administered with sedation to help the patient relax.

During quadrantectomy, a margin of normal breast tissue, skin, and muscle lining is removed around the periphery of the tumor. This decreases the risk of any abnormal cells being left behind and spreading locally or to other parts of the body (a process called metastasis). The amount removed is generally about one-fourth of the size of the breast (hence, the "quadrant" in quadrantectomy). The remaining tissue is then reconstructed to minimize any cosmetic defects, and then sutured closed. Temporary drains may be placed through the skin to remove excess fluid from the surgical site.

Some patients may have the lymph nodes removed from under the arm (called the axillary lymph nodes) on the same side as the tumor. Lymph nodes are small, oval- or bean-shaped masses found throughout the body that act as filters against foreign materials and cancer cells. If cancer cells break away from their primary site of growth, they can travel to and begin to grow in the lymph nodes first, before traveling to other parts of the body. Removal of the lymph nodes is therefore a method of determining if a cancer has begun to spread. To remove the nodes, a second incision is made in the area of the armpit and the fat pad that contains the lymph nodes is removed. The tissue is then sent to a pathologist, who extracts the lymph nodes from the fatty tissue and examines them for the presence of cancer cells.

Diagnosis/Preparation

Breast tumors may be found during self-examination or an examination by a health care professional. In other cases, they are visualized during a routine mammogram. Symptoms such as breast pain, changes in breast size or shape, redness, dimpling, or irritation may be an indication that medical attention is warranted.

Prior to surgery, the patient is instructed to refrain from eating or drinking after midnight on the night before the operation. The physician will tell the patient what will take place during and after surgery, as well as expected outcomes and potential complications of the procedure.