Lumpectomy

Overview

Lumpectomy (lum-PEK-tuh-me) is surgery to remove cancer or other abnormal tissue from your breast.

Lumpectomy is also called breast-conserving surgery or wide local excision because — unlike a mastectomy — only a portion of the breast is removed. Doctors may also refer to lumpectomy as an excisional biopsy.

During lumpectomy, a small amount of normal tissue around the lump (also described as clean or normal margins of breast tissue) also is taken to help ensure that all the cancer or other abnormal tissue is removed.

Lumpectomy helps confirm a diagnosis of cancer or rule it out. Lumpectomy is also a first treatment option for some women with early-stage breast cancer. In cases where cancer is found, lumpectomy usually is followed by radiation therapy to the breast to reduce the chances of cancer returning.

Why it's done

The goal of lumpectomy is to remove cancer or other abnormal tissue while maintaining the appearance of your breast. Studies indicate that lumpectomy is as effective a treatment in preventing a recurrence of breast cancer as removal of the entire breast (mastectomy) for women with early-stage breast cancer.

Your doctor may recommend lumpectomy if a biopsy has shown that you have cancer and that the cancer is believed to be small and early stage. Lumpectomy may also be used to remove certain noncancerous or precancerous breast abnormalities.

You may not be a candidate for lumpectomy for breast cancer if you:

• Have a history of scleroderma, a group of diseases that harden skin and other tissues and make healing after lumpectomy difficult
• Have a history of systemic lupus erythematosus, a chronic inflammatory disease that can worsen if you undergo radiation treatments
• Have two or more tumors in different quadrants of your breast that cannot be removed with a single wide excision, which could affect the appearance of your breast
• Have previously had radiation treatment to the breast region, which would make further radiation treatments too risky
• Have cancer spread throughout your breast and overlying skin, since lumpectomy would be unlikely to remove the cancer completely
• Have a large tumor and small breasts, which may cause a poor cosmetic result
• Don't have access to radiation therapy

Risks

Lumpectomy is a surgical procedure that carries a risk of side effects, including:

• Bleeding
• Infection
• Pain
• Temporary swelling
• Tenderness
• Formation of hard scar tissue at the surgical site
• Change in the shape and appearance of the breast, particularly if a large portion is removed

How you prepare

You'll meet with your surgeon a few days before your lumpectomy. Bring a list of questions to remind you to cover everything you want to know. Make sure you understand the procedure and its risks.

You'll be given instructions about presurgical restrictions and other things you need to know. In most cases, the surgery will be done as an outpatient procedure, so you can go home the same day.

Tell your doctor about any medications, vitamins or supplements you're taking in case something could interfere with the surgery. In general, to prepare for your lumpectomy, it's recommended that you:

• Stop taking aspirin or other blood-thinning medication. Your doctor may ask you to stop taking it a week or longer before the surgery to reduce your risk of bleeding.
• Check with your insurance company to determine whether the procedure is covered and if there are restrictions on where you can have it done.
• Don't eat or drink 8 to 12 hours before surgery, especially if you're going to have general anesthesia.
• Bring someone with you. Besides offering support, another person is needed to drive you home and listen to postoperative instructions because it may take several hours for the effects of the anesthesia to wear off.

What you can expect

Locating the area to be removed

Your lumpectomy procedure begins with locating the area of your breast that contains the abnormality.

If your breast abnormality was detected on a mammogram and confirmed with a biopsy, your radiologist may have placed a tiny marker or clip in your breast during the biopsy. If this is the case, a thin wire or radioactive marker may be inserted in your breast just before surgery and passed down to the marker or clip. Your surgeon can use the wire as a guide to the precise area that needs to be removed during surgery.

If you have a lump or mass in your breast that can be easily felt through the skin, the wire procedure may not be necessary because the surgeon can more easily find the abnormal area to be removed.

Preparing for lymph node removal

Lymph nodes are often removed during surgery to determine whether cancer has spread beyond the breast. Options may include:

• Axillary node dissection. During this procedure, the surgeon removes a number of lymph nodes from your armpit on the side of the tumor. Your surgeon may recommend this procedure if a lymph node biopsy done before surgery shows signs of cancer.

• Sentinel lymph node biopsy. During this procedure your surgeon removes only the first one or two nodes into which a tumor drains (sentinel nodes). These are then tested for cancer. Your doctor may recommend this procedure if there are no concerns about enlarged lymph nodes prior to your surgery.

  Before your surgery, a radioactive substance or blue dye or both is injected into the area around the tumor or the skin above the tumor. The dye travels to the sentinel node or nodes, allowing your surgeon to identify and remove them.

  If no cancer is present, no further lymph nodes need to be removed. If cancer is present, the surgeon will discuss options, such as receiving radiation to the armpit to treat the affected lymph node. If this is what you decide to do, you will not need to have more lymph nodes in the armpit removed.

During the procedure

A lumpectomy is usually performed using general anesthesia, which will make you unaware during the procedure.

Your surgeon will make an incision over the tumor or over the area that contains the wire, remove the tumor and some surrounding tissue, and send it to the lab for analysis. He or she will do the same for the sentinel lymph node or nodes if you're having a sentinel node biopsy or the axillary lymph nodes if you're having an axillary node dissection.

The surgeon will then close the incisions with attention to preserving the appearance of your breast, using stitches (sutures) that will either dissolve on their own or be removed later by your doctor.

After the procedure

After your surgery, you'll be taken to a recovery room. During this time, your blood pressure, pulse and breathing will be monitored.

If you've had outpatient surgery — usually lumpectomy and sentinel node biopsy — you'll be released when your condition is stable.

If you've had axillary node excision, you may need to stay in the hospital for a day or two if you're experiencing pain or bleeding.

Expect to have:

• A dressing (bandage) over the surgery site
• Some pain, numbness and a pinching sensation in your underarm area
• Written instructions about post-surgical care, including caring for the incision and dressing, recognizing signs of infection
• Prescriptions for pain medication and possibly an antibiotic
• Some restrictions of activity
• A follow-up appointment with your doctor, usually seven to 14 days after surgery

Results

The results of your pathology report should be available in a week or two. At the follow-up visit after your surgery, your doctor will explain the report. If you need more treatment, your doctor may recommend:

• More surgery if the margins around your tumor weren't cancer-free
• A medical oncologist to discuss other forms of treatment after the operation, such as hormone therapy if your cancer is sensitive to hormones or chemotherapy or both
• A radiation oncologist to discuss radiation treatments, which are typically recommended after lumpectomy
• A counselor or support group to help you cope with having breast cancer