Lumpectomy

Definition

Lumpectomy (lum-PEK-tuh-me) is surgery to remove cancer or other abnormal tissue from your breast. Lumpectomy is also called breast-conserving or breast-sparing surgery because — unlike a mastectomy — only a portion of the breast is removed. During lumpectomy, a small amount of normal tissue around the lump (clean margins) 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 reduce the chances of cancer returning.

Lumpectomy

Lumpectomy

During a lumpectomy, your surgeon makes an incision large enough to remove the tumor and a margin of healthy tissue surrounding the tumor. The rest of your breast remains intact. ...

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 as removal of the entire breast (mastectomy). Your doctor may recommend lumpectomy if:

• You've had a biopsy — removal of a small sample of breast tissue for lab testing — that indicates the lump is cancer
• Your biopsy confirms you have cancer, and the cancer is small and early-stage, for which breast-conserving surgery is a viable option
• You have a noncancerous (benign) breast mass that warrants removal

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, or systemic lupus erythematosus, a chronic inflammatory disease
• Have two or more tumors in different quadrants of your breast
• Can't have radiation therapy because you've had previous radiation, so that another course of radiation would give you an excessively high total dose
• Have cancer spread throughout your breast
• Don't have enough cancer-free area around the tumor after two operations
• Have a large tumor and small breasts, because you may not be happy with the cosmetic results
• Don't have access to radiation therapy
• Have a rare skin condition, xeroderma pigmentosa, in which your skin is extremely sensitive to ultraviolet light

Risks

Lumpectomy is a surgical procedure and, as with any surgery, bleeding and infection at the surgical site are potential risks. Other risks associated with lumpectomy include:

• Pain
• Temporary swelling
• Tenderness
• Formation of hard scar tissue at the surgical site
• Numbness, particularly under your arm from lymph node removal, that may be lasting
• Change in the shape of the breast, particularly if a large portion is removed

Call your doctor if you develop a fever after lumpectomy, or if pain, redness and swelling persist longer than a few days. These may be indications of infection.

How you prepare

You're likely to 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.

Be sure your doctor knows of 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 eight 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

In many cases lumpectomy also involves testing lymph nodes to determine whether the cancer has spread. For an axillary node biopsy, the surgeon removes a number of nodes, usually no more than 20, from your armpit on the side of the tumor. Many doctors now use sentinel lymph node biopsy, in which your surgeon removes the first node or nodes into which a tumor drains. The node removal is done during the surgery. However, if you're having sentinel node biopsy, you'll

• Arrive several hours before your surgery
• Have a radioactive substance or blue dye or both injected into the area around the tumor or into the skin above the tumor

In the hours before your surgery, the dye will travel to the sentinel node or nodes, allowing your doctor to see where they are and remove them during surgery.

During the procedure
For the lumpectomy itself, you will:

• Undress and put on a hospital gown
• Have an intravenous (IV) line put in, usually into a vein in your arm, so that your medical team can give you medication you may need during surgery
• Possibly be given a sedative
• Meet with your surgeon to go over any last-minute concerns
• Meet with an anesthesiologist or nurse anesthetist to go over the type of anesthesia you'll be given and get answers to questions you have
• Be transported on a wheeled bed (gurney) to the operating room
• Be given anesthesia to make you unconscious (general) or to numb the area (local) for the duration of the procedure, which may take an hour or two

Your surgeon will then make an incision over the tumor, 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 biopsy. 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 need to be removed later by your doctor.

After the procedure
After your surgery, you'll be taken to a recovery room. During this time, a nurse will monitor your blood pressure, pulse and breathing. 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 biopsy, you may need to stay in the hospital a day or two so the medical staff can monitor your condition.

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

Lumpectomy

Lumpectomy

During a lumpectomy, your surgeon makes an incision large enough to remove the tumor and a margin of healthy tissue surrounding the tumor. The rest of your breast remains intact. ...

Sentinel node biopsy

Sentinel node biopsy

To determine whether cancer has spread to the nearby lymph nodes, doctors may use a sentinel node biopsy. Doctors determine which lymph node is likely to be the first stop for spreading cancer cells ...

Results

The results of your pathology report should be available within a week. At your 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 plastic surgeon, if you're unhappy with the appearance of your breast after lumpectomy and want to discuss reconstruction
• A counselor or support group to help you cope with having breast cancer