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  • Writer's pictureSurviving Breast Cancer

What Are Surgical Margins?

Updated: Oct 7, 2022


Why are surgical margins important in breast cancer surgery

If surgery is part of your or a loved one's plan , then you’ll probably be hearing a term called, “surgical margins.” Understanding a surgical margin is one of the many ways your medical team can determine whether or not surgical intervention was successful or not, and whether or not further procedures will be necessary. As a result, surgical margin can be a source of worry for many facing breast cancer. This article will hopefully be able to clear up a few points on what a margin is, what it can tell you, and what happens after.

Understanding your pathology report

National comprehensive cancer network provides the most up to date information on breast cancer guidelines. A pathology report is a medical document that contains information about the tissue and cells that were removed during your biopsy or surgery. The report also includes information about the type of breast cancer you have and how aggressive it is. Pathology reports can be confusing, but it’s important to review them with your doctor so that you can better understand your diagnosis and treatment options.

If you’ve been diagnosed with breast cancer, your pathology report can provide valuable information about your disease. Pathology reports can help your doctor determine the type of breast cancer you have and how aggressive it is. This information is important in developing a treatment plan that is tailored to your individual needs.


Pathology reports can be confusing, but it’s important to review them with your doctor so that you can better understand your diagnosis and treatment options. If you have questions about your pathology report, don’t hesitate to ask your doctor for clarification.



What happens after my tumor and breast tissue is removed

After your breast tissue is removed, it will be sent to a laboratory where a pathologist will examine it under a microscope. The pathologist will look for cancer cells and determine the type of breast cancer disease you have. The pathology report will also include information about the tumor’s grade, which is a measure of how aggressive the cancer is.

The pathology report can provide valuable information about your disease and help your doctor develop a treatment plan that is tailored to your individual needs. If you have questions about your pathology report, don’t hesitate to ask your doctor for clarification.

How to measure a surgical margin?

A surgical margin is an examination of the removed breast tissue following a surgery, to see where cancerous cells are in relation to the edge of the sample. Following a breast cancer removal surgery, pathologists will examine the distance between the cancer cells and the edge of the removed breast tissue, or the size of the border surrounding a removed tumor.


Surgical margins are the tissue that surrounds a tumor that has been removed during surgery. The width of the margins varies depending on the type of cancer being treated. For example, breast cancer margins are typically 1-2 cm, while melanoma margins are usually 5-7 cm. The goal of surgery is to remove the entire tumor along with a margin of healthy tissue to reduce the high risk of recurrence. margins are also important in determining the stage of cancer, which helps guide decisions. Margins are classified as either microscopically positive or negative. Microscopically positive margins mean that there are cancer cells at the edge of the removed tissue sample, while negative margins mean that there are no cancer cells at the edge of the sample.

Knowing Your Surgical Margin Status

Understanding your margin is also important in determining the stage of cancer, which helps guide treatments. When your breast tissue is sent to the pathologist they will preform an analysis to determine if the surgery achieved clear margins. Margins are classified as either microscopically positive or negative. Microscopically positive surgical margins, or involved margins, mean that there are cancer cells at the edges of the tissue that was removed during surgery. This means that not all of the breast cancer cells were removed and that there is a higher risk of the cancer recurring. Negative surgical margins, or clear margins, mean that there are no breast cancer cells at the edges of the removed tissue, which signifies that all of the breast cancer cells were likely removed during surgery. Finally, close margins is when it is unclear if there are cancer cells at the edge of the tissue or not, or the cancer is very close to the edge of the tissue.



What happens if I have a positive margin result?

The term “positive surgical margin” (PSM) is used when cancer cells are found at the edge of the removed tissue sample. This means that all of the cancer may not have been removed during surgery and additional treatment, such as radiation therapy, may be needed. A PSM can also be a sign that the cancer may come back (recur). The chance of the cancer recurring is higher if the PSM is close to the edge of the removed tissue or if there are more than one area of PSM.


If you or a loved one have a been diagnosed with breast cancer and receive this result it may feel scary or like the surgery wasn’t successful. However, it’s important to keep in mind that a positive margin doesn’t necessarily mean that the breast cancer will come back or that the surgery wasn’t successful. In fact, many breast cancer patients with positive margins go on to have successful breast cancer treatment and remain cancer-free.


What does PSM indicate about the cancer?

There are a few reasons why you may have a positive surgical margin even though the surgery was successful in removing the breast cancer tumor. One reason is that breast cancer cells can be very small, so it’s possible for some breast cancer cells to remain even after surgery. Additionally, the surgeon may have removed a larger margin of breast tissue than necessary to ensure all of the breast cancer cells were removed.


It’s also important to keep in mind that breast cancer can spread beyond the breast. So, even if the surgeon removes the breast cancer tumor and a wide margin of breast tissue, there’s a possibility that breast cancer cells have already spread to other parts of the body. This is why breast cancer patients with this diagnosis often receive additional treatment, such as radiation therapy, to help kill any remaining breast cancer cells and reduce the risk factors of the breast cancer recurring.


How can you lower your risk of having positive margins?

There are a few things you can do to lower your risk including:

- Choose a breast cancer surgeon who is experienced in the type of surgery you are looking to have

- Have a preoperative breast MRI in addition to a mammogram

- Discuss your r treatment options with your surgeon in advance of the surgery.

What treatment options are available if you have a positive margin?

If you have breast cancer and did not have clear margins, your cancer treatment team will likely recommend additional treatment, such as radiation to help kill any remaining cancer cells and reduce the risk of the breast cancer recurring.

Radiation is a common therapy for breast cancer patients. In fact, studies have shown that breast cancer patients who receive radiation treatment after surgery have a lower risk of the breast cancer recurring.


If you or a loved one has breast cancer and positive margins, it’s important to talk to your healthcare team about all of your treatment options. Together, you can make a treatment plan that’s best for you.

What happens if I have a negative surgical margin status?

If you or a loved one has been diagnosed with breast cancer and receive this result, it’s good news! A NSM indicates that the surgery was successful in removing all of the cancer from the breast. Additionally, it means that there’s a lower risk of the cancer recurring.

NSM is often used to describe hope this article helped to clear up some questions you may have had about surgical margins. If you or a loved one has been diagnosed with breast cancer, it’s important to talk to your healthcare team about all of your treatment options. Together, you can make a treatment plan that’s best for you.

If you or a loved one have been diagnosed with breast cancer and receive a negative margins , it means that there were no breast cancer cells at the edges of the removed tissue. This is generally good news, as it suggests that all of the breast cancer cells were likely removed during surgery. In most cases, no additional treatment will be necessary following surgery.

Breast cancer patients with negative margins have a lower risk of the cancer recurring. However, it’s important to keep in mind that breast cancer can still come back even if you have negative margins. That’s why it’s important to follow up with your breast cancer treatment team and get regular breast cancer screenings, even if you’ve had breast surgery with negative surgical margins.

What happens if I have a close surgical margin status?

Close surgical margins, also called close margins or margin-negative breast cancer, refer to cancer tumors that are very close to the edge of the removed tissue but don’t have any breast cancer cells at the edges. Close margins are not considered positive because there are no breast cancer cells at the edge of the tissue. However, close margins may require additional treatment, such as radiation therapy, to help reduce the risk of the cancer recurring.

Your team will likely recommend additional treatment. In most cases, this additional treatment will be radiation therapy.


When will I know the results?

Margin results are usually given a week after surgery, and it also depends on what type of surgery you are getting. If you have negative margins, usually no follow-up surgery is recommended, although you may undergo further chemotherapy and/or radiation. However, for both positive and close margins, this means that further surgery may be required.


The different types of breast cancer and how they affect surgical margins

While the reported nationwide rate of PSM for breast cancer is about 20%, according to a couple of reviews of margin outcomes, the actual statistics may be much smaller; closer to 5 or 6% due to the national rate not accounting for repeated procedures on aggressive cases. These statistics also vary between the types or stages of breast cancer, as well as the type of procedure a person chooses to undergo (total mastectomy vs. partial). Possible risk factors for include HER2+ cancers, a lobular histology, and more conservative, breast-conserving surgery types. However, despite these risk factors, the occurrence of positive margins for breast cancer in both men and women both declined over one study period of 10 years. This means that surgeons are improving over time at removing most/all of the cancerous tissue for a given surgery, and the chances that you or a loved one will be faced with a positive margin are lower than they once were.


According to guidelines published by the American Society of Breast Surgeons, the recommended course of action for those with negative margins are to not repeat a procedure, for those with close margins are to rely upon genetic markers and location of close margins in deciding whether or not to repeat a procedure. Despite improving rates, the possibility of having positive margins at all can be a source of great stress and worry for many. Not knowing what surgical margins you’ll have following a potentially major, life altering surgery, can often lead to adverse consequences, such as insomnia, depression, anxiety, and anticipatory grief.


Does your surgical choice of lumpectomy or mastectomy's improve your chances of clear margins?

Although there are some clear advantages to having a mastectomy over a lumpectomy, such as lower risk of cancer recurrence and no need for radiation therapy, the decision of which surgery to have is often a very personal one. Some people may feel that the disadvantages, such as a longer recovery time, more scarring, and a higher risk of complications, are not worth the slightly increased chance of clear margins. Ultimately, the decision should be made between you and your breast cancer treatment team, taking into account all of the available information on your individual case. It’s important to remember that even if you do have PSM, it doesn’t mean that your breast cancer treatment has failed. In most cases, further surgery or radiation therapy can be successful in achieving clear margins. And although the prospect of more surgery may be daunting, it’s important to remember that you are not alone in this journey. There are many resources available to help you through this difficult time, and with the support of your loved ones, you will get through it.


Ways to improve your chances of getting clear margins in breast cancer surgery


There are a few ways that you can improve your chances of getting clear margins. First, you can choose to have a mastectomy instead of a breast-conserving surgery. While a mastectomy is more invasive, it also gives the surgeon a clear view of the breast tissue and allows them to remove more tissue. Second, you can choose to have a genetic test before surgery. This test can identify if you have certain genes that are linked to breast cancer. If you do have these genes, your surgeon may be able to remove more tissue to ensure clear margins. Finally, you can ask your surgeon about their experience with breast surgery. Choose a surgeon who has performed the procedure many times and has a good track record. While there is no guarantee that you will get clear margins, following these tips can improve your chances.

How to reduce stress well waiting on the results of your surgery

Some steps that you can take to mitigate these include reaching out to a support group or mental health professional or partaking in creative works such as reading, writing, drawing, dance, and journaling. Finally, it is always a good idea to discuss your concerns with your medical team, as they will be able to best address your individual case. Grappling with surgical margins is something that many will have to face throughout their cancer journey, but it’s important to remember that they are not entirely indicative of how your story will go. At SurvivingBreastCancer.org, we want you to know that we are here with you, no matter how your journey may progress.

How to cope with a diagnosis of a positive margin status after surgery?

If you or a loved one receives a positive margin diagnosis, it’s important to remember that you are not alone. In fact, breast cancer patients with positive surgical margins often go on to have successful breast cancer treatment and remain cancer-free.


If you’re struggling to cope with a diagnosis of positive margins, there are a few things you can do:

  • Talk to your treatment team about your diagnosis and treatment options

  • Join a breast cancer support group

  • Talk to a counselor or therapist who specializes in helping people cope with breast cancer


It’s important to remember that you are not alone. There are many resources available to help you cope with your diagnosis and treatment.

What are the long-term effects of breast surgery?

The long-term effects of breast surgery will vary depending on the type of surgery you had. For example, if you had a lumpectomy, the long-term effects may be less severe than if you had a mastectomy. Additionally, whether or not you received radiation therapy after surgery can also affect

the long-term effects.

Some common long-term effects of surgery include:

- Pain at the site of the incision

- Lymphedema (swelling in the arm)

- Numbness in the breast or chest

- Infection

- Scarring

If you’re experiencing any long-term effects from surgery, it’s important to talk to your doctor. They may be able to prescribe medications or suggest treatments that can help alleviate some of the side effects.


Will a PET or CT scan be required?

A PET or CT scan may be required if your surgical margins are close or if there is a chance that cancer cells may have spread to other parts of your body. These scans can help your doctor determine whether or not you will need additional treatment. Breast cancer patients with positive surgical margins often go on to have successful breast cancer treatment and remain cancer-free. Talk to your treatment team about your diagnosis and treatment options- Join our SBC breast cancer support group (aka Thursday Night Thrivers)

What questions should I ask my breast surgeon?


If you are scheduled to have breast surgery, it’s important to ask your surgeon any questions you may have about the procedure. Some common questions patients ask their surgeons include:

  • What type of surgery will I be having?

  • What are the risks and complications associated with this type of surgery?

  • How long will the surgery take?

  • What can I expect the recovery process to be like?

  • Will I need to stay in the hospital after the surgery?

  • When can I expect to see results from the surgery?

Asking questions can help ease some of the anxiety and stress you may be feeling about upcoming surgery. It’s also a good opportunity to get more information about what to expect during

and after the procedure.

What are the different types of breast cancer surgery?

The type of surgery you have will depend on a number of factors, including the stage of your cancer, the size of your tumor, and your overall health. The three most common types of breast surgery are:

  • Lumpectomy: A lumpectomy is a minimally invasive surgery in which only the entire tumor and a small margin of healthy tissue surrounding it are removed. This type of surgery is typically used for early-stage breast cancers.

  • Mastectomy: A mastectomy is a more extensive surgery in which the entire breast is removed. This type of surgery may be recommended for larger entire tumors or for patients who are at high risk for the cancer returning.

  • Breast reconstruction: Breast reconstruction is a surgery that is performed to rebuild the shape of the breast after a mastectomy. This type of surgery is typically done at the same time as a mastectomy or may be done in a separate procedure.

  • Aesthetic Flat Closure

What are some common side effects of breast cancer surgery?

Some common side effects of breast surgery include:

  • Pain at the site of the incision

  • Swelling and bruising

  • Fatigue

  • Nausea and vomiting

  • Difficulty urinating or having a bowel movement

  • Lymphedema (swelling in the arm)

  • Numbness in the breast or chest

  • Infection

  • Scarring

How to cope with a breast cancer diagnosis?

If you’ve been diagnosed with breast cancer, you may be feeling a range of emotions, including shock, fear, sadness, and anger. It’s important to remember that everyone copes with a cancer diagnosis differently. There is no right or wrong way to feel. Some people find it helpful to talk to a counselor or join a support group. Others find comfort in spending time with family and friends. There are also a number of resources available to help you cope with a breast cancer diagnosis, including the following:


  • American Cancer Society: The American Cancer Society offers information and support for people affected by cancer.

  • National Cancer Institute: The National Cancer Institute provides information about cancer treatment, research, and prevention.

  • Breast Cancer Research Foundation: The Breast Cancer Research Foundation funds breast cancer research and provides information about breast cancer.

  • Susan G. Komen: Susan G. Komen is a nonprofit organization that offers support and resources for people affected by breast cancer.



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