external radiation boost or internal implant as well as the usual external beam therapy to the entire breast.
• Removal of a larger wedge or portion of the breast, again with an axillary node dissection and radiation to the
  breast. This has a lower failure rate than lumpectomy with radiation. For both lumpectomy and wedge
  resections, the margins must be free of cancer. If they are not, there is a much higher local failure rate.
  Sometimes (less than 10 percent of the time for Stages I and II) a tumor seems small, but with microscopic
  study is found in multiple sites or is found to be so extensive that a mastectomy may be needed to remove all
  cancer and improve the chance for cure.
• Modified radical or a total mastectomy, with removal of axillary Iymph nodes . Radiotherapy is sometimes
  used after a modified radical mastectomy in patients at high risk for microscopic residual tumor that could lead
  to a recurrence in the area of surgery. If possible, however, the surgeon will ensure that the tissues at the edge
  of the surgical incision are free of cancer cells . If radiotherapy is used, it is 90 to 95 percent effective in
  eliminating these cells and preventing tumor recurrences in the skin of the chest, which is a very troublesome,
  hard to manage problem that is far easier to prevent.
      Removing the tumor and a portion of surrounding tissue while conserving a major part of the breast, usually
  if followed by radiation therapy , provides a cure rate about the same as the modified radical mastectomy.
      The conventional recommendation has been to remove the axillary lymph nodes, since about one-third of
  patients who do not have obviously enlarged nodes still have microscopic involvement (positive nodes
  reclassifies the disease as Stage II, a treatment category requiring adjuvant chemotherapy or hormone therapy).