discount cialis A total mastectomy; radiotherapy is optional after mastectomy OR A breast conserving procedure lumpectomy, quadrantectomy or partial mastectomy with margins clear of invasive cancer and ductal breast carcinoma in situ DCIS; the local pathologist must document negative margins of resection in the pathology report; if all other margins are clear, a positive posterior deep margin is permitted, provided the surgeon documents that the excision was performed down to the pectoral fascia and all tumor has been removed; likewise, if all other margins are clear, a positive anterior superficial; abutting skin margin is permitted provided the surgeon documents that all tumor has been removed; radiation therapy to the conserved breast is required; patients may be randomized before, during or after completion of radiation therapy to the breast