Ductal Carcinoma in Situ Surgery

Ductal carcinoma in situ (DCIS) is a noninvasive form of breast cancer that begins when abnormal cells grow within the lining of a milk duct. At this early stage, the abnormal cells remain confined to the duct and do not cause noticeable symptoms, such as a breast lump. However, if left untreated, DCIS can progress into invasive breast cancer, spreading beyond the walls of the duct and potentially affecting nearby tissues.

DCIS is relatively common in the United States, accounting for approximately 20% of all new breast cancer diagnoses. Although it primarily affects women older than 50, it can also affect younger women and men.

Surgery is the primary treatment for ductal carcinoma in situ, which is classified as stage 0 breast cancer. Due to the localized nature of the tumor, the surgeon can often remove all abnormal cells during a single procedure, significantly reducing the risk of recurrence.

"Although we understood the severity of what I was dealing with, Dr. Susan Hoover promised and assured me that I was going to be on the other side of cancer in two years."

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There are several approaches to DCIS surgery. The optimal procedure can vary depending primarily on the extent of the tumor and the patient’s preferences. The types of ductal carcinoma in situ surgery include:

Breast-sparing lumpectomy surgery for ductal carcinoma in situ

Lumpectomy, also known as breast-conserving surgery, is a common treatment for DCIS. The procedure involves removing the cancerous cells along with a slim margin of surrounding healthy tissue. The rest of the breast tissue is preserved. Lumpectomy is often recommended for localized DCIS because it can effectively eliminate abnormal cells while maintaining the natural shape and appearance of the breast.

In general, lumpectomy involves:

• Anesthesia – The patient will be placed under general anesthesia to ensure comfort throughout the procedure.
• Tumor removal – After making an incision over or near the targeted area of the breast, the surgeon will carefully remove the DCIS-affected tissues and margin to help ensure no abnormal cells remain.
• Tissue examination – The excised tissue will be sent to a pathology lab to confirm the margin is clear, which means no cancerous cells are found at the edges. If the margin is not clear, additional treatment may be needed.
• Closure – After closing the surgical incision with sutures, the surgeon will apply a bandage to aid healing.

In most cases, lumpectomy is performed on an outpatient basis, allowing the patient to return home the same day. Mild soreness, swelling and bruising around the surgical site are common, and full recovery can take a few weeks. After lumpectomy, many patients elect to undergo radiation therapy to further reduce the risk of cancer recurrence, which is usually monitored through regular medical checkups and mammograms.

For a patient diagnosed with ductal carcinoma in situ, a breast-sparing lumpectomy can be an excellent treatment option with a high success rate. Less invasive than mastectomy—but equally effective when combined with radiation therapy—lumpectomy is generally followed by a quick recovery.

Single mastectomy surgery for ductal carcinoma in situ

Single mastectomy is a surgery that involves removing one breast to treat breast cancer. This procedure might be suitable for a patient with widespread or high-risk DCIS, where breast-conserving lumpectomy may not be sufficient to remove all abnormal cells. Mastectomy may also be considered to address a DCIS recurrence after lumpectomy followed by radiation therapy. Additionally, some patients with stage 0 breast cancer elect mastectomy due to a strong family history of breast cancer, a certain genetic mutation, such as BRCA1 or BRCA2, or personal preference. A mastectomy can greatly reduce the risk of DCIS recurrence by removing all breast tissue.

Typically, single mastectomy involves:

• Anesthesia – The patient will receive general anesthesia to ensure a pain-free procedure.
• Breast tissue removal – The surgeon will remove the entire affected breast, including all glandular tissue. In most cases, the chest muscles are left intact.
• Sentinel lymph node biopsy (if necessary) – Although DCIS is noninvasive, a lymph node biopsy may be performed if there is concern about the possibility of cancer spread.
• Closure and drain placement – The surgeon will close the incision with sutures and place surgical drains to help prevent fluid buildup.
• Recovery and monitoring – The patient will be monitored in a recovery area and may be discharged the same day or after a brief hospital stay.

During the first few weeks after single mastectomy, the patient may experience soreness and limited arm movement. Most patients fully recover within four to six weeks. Regular medical check-ups and imaging of the remaining breast will be recommended to monitor for any signs of recurrence. Some women elect to undergo breast reconstruction surgery either immediately after mastectomy or at a later date.

Preventive double mastectomy surgery for ductal carcinoma in situ

Preventive double mastectomy, or bilateral mastectomy, is a surgery that involves removing both breasts to treat cancer and reduce the risk of future cancer. Although DCIS is a noninvasive form of breast cancer, some patients opt for double mastectomy as a preventive measure, even if less invasive treatments, such as lumpectomy or single mastectomy, may be feasible.

Usually, a double mastectomy involves:

• Anesthesia – The patient will be placed under general anesthesia for the duration of the procedure.
• Breast tissue removal – The surgeon will remove all breast tissue from both breasts, typically preserving the chest muscles.
• Sentinel lymph node biopsy (if necessary) – Although DCIS is noninvasive, a lymph node biopsy may be performed if there is concern about possible cancer spread.
• Breast reconstruction (optional) – The patient may choose to have immediate or delayed breast reconstruction surgery using implants or tissue derived from another part of the body.
• Closure and drain placement – After closing the incisions, the surgeon may place surgical drains to help remove excess fluid during the healing process.
• Recovery – Typically, full healing takes four to six weeks. During that time, the patient may experience temporary swelling, soreness and limited upper body movement.
• Physical therapy – Some patients benefit from physician-approved stretches and exercises to help restore arm mobility and strength.
• Follow-up monitoring – Even after both breasts are completely removed, a slight risk of cancer recurrence in the chest wall will remain. Therefore, regular medical checkups will be recommended, but routine breast cancer screenings and mammograms may be unnecessary.

Prophylactic mastectomy can be highly effective in preventing DCIS recurrence. However, it is a major surgery that should be considered only after exploring less invasive alternatives, such as active surveillance and hormone therapy.

What to expect before, during and after ductal carcinoma in situ surgery

In the days leading up to DCIS surgery, the patient may naturally experience some apprehension. However, understanding the procedure can help alleviate concerns and foster confidence. Being well-informed about each stage of the process—from preoperative preparations to post-surgical recovery—can enable the patient to take a more proactive role in their care, enhancing their experience, outcome and quality of life. With the right knowledge and support, the patient can navigate their surgical journey with greater ease and preparedness.

How to prepare for ductal carcinoma in situ surgery

Whether the patient is scheduled for lumpectomy or mastectomy, proper preparation for DCIS surgery can help ensure a smooth experience, procedure and recovery. This may involve:

• Undergoing preoperative medical evaluations – To be cleared for DCIS surgery, the patient may need several medical assessments, such as blood work, imaging scans and an electrocardiogram (EKG).
• Adjusting medications and lifestyle – The patient should review their medications with their surgeon, who will advise whether any need to be adjusted or temporarily stopped. Additionally, tobacco use can delay healing, and alcohol consumption may interfere with anesthesia and recovery, so it is best to avoid smoking and drinking both before and after DCIS surgery.
• Fasting – The patient will likely be instructed to stop eating and drinking several hours before the procedure to help prevent anesthesia complications.
• Wearing comfortable clothing – Loose-fitting, button-up shirts and comfortable pants are recommended for easy dressing and comfort after surgery.
• Arranging transportation – Because anesthesia can affect mental alertness and physical coordination, the patient will need to ask a family member or friend to drive them home after DCIS surgery.
• Setting up a recovery space – The patient may want to prepare a dedicated resting area at home with extra pillows, blankets and other necessary items placed within easy reach.
• Stocking up on essentials – Having any necessary post-surgical supplies on hand, such as pre-prepared meals, comfortable clothing, medications and gauze bandages, can help make the recovery process easier.
• Seeking support – Enlisting help from family members and friends for household tasks during the first few days after DCIS surgery can promote a smoother recovery.
• Managing post-surgical expectations – The surgeon will explain what the patient can expect after DCIS surgery, covering topics such as pain management, activity restrictions and follow-up care.

What happens during ductal carcinoma in situ surgery?

The specific steps of DCIS surgery can vary depending on the type of procedure being performed. However, regardless of whether the patient is undergoing lumpectomy or mastectomy, they can generally expect:

Preoperative preparation

After arriving at the hospital or surgical center, the patient will be prepped for the procedure. Anesthesia will be administered; most likely, general anesthesia will be used to keep the patient asleep during surgery. The surgical team may use wire localization, which involves using imaging guidance to precisely insert a thin wire into the breast to pinpoint the tumor if it is not easily felt.

The surgical procedure

If the patient is undergoing lumpectomy, the surgeon will make an incision in the breast and remove the tumor along with a slim margin of surrounding healthy tissue. The excised tissue will be sent to a pathology lab to ensure the margin is clear of cancerous cells. After the incision is closed with sutures, the surgical site will be bandaged. Most patients can go home the same day.

If the patient is undergoing mastectomy, all breast tissue will be removed, including the nipple and areola if necessary. If the patient opts for breast reconstruction, the reconstructive procedure may be performed immediately after the DCIS surgery or scheduled for a later date. To help prevent fluid buildup, the surgeon may place surgical drains around the treatment site. The patient may remain in the hospital for one to two days for monitoring before being discharged home.

What to expect after ductal carcinoma in situ surgery

After DCIS surgery, the patient will be monitored for a few hours in a recovery area before being discharged home (after lumpectomy) or transferred to a hospital room (after mastectomy). Pain medications will be provided to ease discomfort, and the patient will receive instructions on wound care, activity restrictions and follow-up appointments. In the case of lumpectomy, radiation therapy is often recommended afterward to help reduce the risk of recurrence. Depending on the patient’s risk factors, hormone therapy may be considered to reduce the chance of future breast cancer.

What are the risks and potential complications of ductal carcinoma in situ surgery?

While DCIS surgery is generally safe and effective, like any surgical procedure, it carries certain risks and potential complications. The likelihood of complications can vary based on factors such as the type of surgery performed (lumpectomy or mastectomy) and the patient’s overall health and healing response.

General surgical risks of ductal carcinoma in situ surgery include:

• Bleeding (hematoma formation) – Some patients may experience excessive bleeding during or after surgery, requiring medical intervention.
• Infection – The surgical incision can become infected, leading to redness, swelling, pain or discharge. Antibiotics may be prescribed to help prevent or treat infection.
• Pain – Mild to moderate discomfort is common after DCIS surgery, especially in the days following the procedure. Pain management strategies include medications and proper wound care.
• Scarring – The surgical incision will leave a scar that will likely fade over time, although it can potentially become thickened or raised.

Complications specific to lumpectomy include:

• Fluid buildup (seroma) – Fluid may collect near the surgical site, possibly requiring drainage.
• Changes in breast shape or appearance – Depending on the amount of tissue removed, the breast may appear smaller, dimpled or asymmetrical after DCIS surgery.
• Residual cancer cells – If cancerous cells are found at the surgical margin, further surgery may be considered to remove the remaining abnormal tissue.

Complications specific to mastectomy include:

• Delayed wound healing – Some patients, especially those with diabetes or poor blood circulation, may experience slow healing.
• Swelling in the arm or chest (lymphedema) – If lymph nodes are removed during DCIS surgery, fluid buildup can cause persistent swelling in the arm, chest or armpit.
• Numbness and nerve damage – Some patients experience long-term numbness or tingling in the chest or armpit due to nerve disruption.
• Phantom breast sensations – After mastectomy, some patients may feel discomfort, itching or tingling in the area where the breast tissue was removed.

Risks associated with breast reconstruction include:

• Implant-related issues – If the patient elected breast reconstruction with implants, possible complications include implant rupture, scar tissue tightening around the implant (capsular contracture) and infection.
• Flap reconstruction complications – If tissue from another part of the body was used to reconstruct the breast, risks include poor blood supply, tissue necrosis and breast asymmetry.

Potential emotional and psychological effects of DCIS surgery include:

• Body image concerns – Changes in breast appearance can sometimes affect a woman’s self-confidence and emotional well-being.
• Anxiety or depression – Some patients experience emotional distress after DCIS surgery, especially mastectomy. Seeking support from counselors and peer groups may be beneficial.

To minimize the risks and potential complications of ductal carcinoma in situ surgery, the patient should:

• Follow all preoperative and postoperative care instructions.
• Attend follow-up appointments to monitor healing and address any concerns early.
• Practice proper wound care to prevent infection and promote healing.
• Seek support from healthcare professionals, family members, friends and/or support groups to manage any emotional challenges.

Benefit from world-class care at Moffitt Cancer Center

The multispecialty team in Moffitt’s nationally renowned Don & Erika Wallace Comprehensive Breast Program takes a collaborative, patient-first approach to breast cancer care. In addition to cutting-edge diagnostic and treatment services, our patients have access to promising new DCIS surgery techniques available only through our robust clinical trials program.

If you would like to learn more about ductal carcinoma in situ surgery, you can request an appointment with a specialist at Moffitt by calling 1-888-663-3488 or submitting a new patient registration form online. We do not require referrals.