small tumours may be amenable to conservative treatment, but the patient may have a strong feeling that mastectomy will provide more peace of mind
patient may prefer to avoid radiotherapy with its attendant complications
size of tumour:
tumours greater than 2-3cm in small breasts; generally, removal of masses greater than this size results in a cosmetic defect that is unacceptable
in larger breasts, masses up to 4cm have been treated with breast conservation with little aesthetic deficit and what is believed to be little influence on prognosis
those with clinical or radiographic evidence of more than one tumour:
more prevalent with lobular carcinoma
multifocal disease:
presence of synchronous tumour within the the same quadrant
increases with increasing primary tumour size
widespread multifocal disease is probably best treated with mastectomy
multicentric disease: presence of synchronous tumour outside of the same quadrant
poor tumour differentiation
centrally-located tumours:
often difficult to excise by conservative measures without poor cosmesis due to loss of nipple
many women prefer mastectomy to simple conservation if the nipple will be lost by both techniques
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