Lumpectomy

Lumpectomy

Also called: Limited Breast Surgery, Segmental Mastectomy, Breast Conservation Therapy, Tylectomy, Breast Sparing Surgery, Breast Conservation Surgery, Partial Mastectomy, Segmental Breast Excision

Summary

A lumpectomy is a surgical procedure to remove abnormal and sometimes cancerous tissue from the breast. Some surrounding healthy tissue also is removed to increase the likelihood that all of the cancer is removed. Lumpectomy is considered a breast-conserving surgery because its goal is to remove the abnormal tissue while saving as much of the breast as possible.  In a lumpectomy, lymph nodes under the arm also need to be removed and examined in either a sentinel lymph node biopsy or an axillary lymph node dissection.

Because lumpectomies leave the breast mostly intact, they are often the preferred form of surgery when treating breast cancer. However, they are usually effective only in the early stages of breast cancer, and almost always are followed by 5 to 7 weeks of radiation therapy. In some cases, women also may need chemotherapy before or after a lumpectomy. Some  circumstances may preclude women from being good candidates for lumpectomies.

Lumpectomies are usually performed on an outpatient basis and do not require an overnight hospital stay. Recovery from lumpectomy is significantly easier than recovery from mastectomy and most women return to normal activities within a few weeks. Patients who have lumpectomies in the early stages of breast cancer have survival rates nearly identical to patients who have more radical surgery, such as a mastectomy. A number of factors must be considered when choosing between a lumpectomy and mastectomy. Consultation with physicians is the best way for patients to determine if lumpectomy is the appropriate treatment for them.

About lumpectomy

A lumpectomy is a breast cancer treatment in which alump in the breast and some normal tissue surrounding it are removed. Obtaining a clean margin around the lump helps increase the likelihood that no cancer cells remain in the breast.

As a form of breast conservation therapy, lumpectomy is surgery that removes a cancer while allowing a woman to preserve the natural appearance of her breast as much as possible. The procedure also includes the removal of lymph nodes from under the arm in either a sentinel node biopsy or axillary node dissection for examination by a pathologist. This is performed to determine if the cancer has metastasized to the lymphatic system, which is vital to planning cancer treatment.

Following the lumpectomy, patients whose removed tissue is confirmed to be cancerous are likely to have radiation therapy for about six weeks. Sometimes chemotherapy treatment will be necessary in addition to radiation therapy.

A woman diagnosed with breast cancer who requires surgery will likely consult with her cancer care team about whether to treat the cancer with a lumpectomy or a mastectomy. For most women with stage I or stage II breast cancer, a lumpectomy or a partial mastectomy is as good as a full mastectomy, with survival rates nearly identical, according to the American Cancer Society. 

Lumpectomies are often preferred because they remove the cancer while preserving the natural look of the breast. However, lumpectomies also require a woman to have several weeks of radiation after surgery, which is usually not the case after a mastectomy. In addition, other factors can affect whether or not a woman is a good candidate for a lumpectomy.

Lumpectomies are not advised for women:

  • Who have already had radiation therapy to the affected breast
  • With two or more areas of cancer in the same breast too far apart to be removed through a single surgical incision (including involvement of a lymph node)
  • Who have had an initial lumpectomy along with re-excision that has not completely removed the cancer
  • With serious connective tissue diseases such as scleroderma (thickening and hardening of the skin), which make them especially sensitive to side effects of radiation therapy
  • Who are pregnant (risking harm to the fetus from the radiation)
  • With a tumor larger than 5 centimeters (2 inches) that does not shrink much with chemotherapy
  • With cancer that is large relative to a small breast

In addition, women must consider their personal feelings and lifestyle when considering a lumpectomy versus a mastectomy. Despite the evidence that the two procedures have similar outlooks for recovery, some women have greater fears about recurrence of cancer if breast tissue remains. In addition, a woman’s work schedule or family commitment may not accommodate the usual course of radiation therapy that follows a lumpectomy. All of these factors play a role in choosing lumpectomy for breast cancer treatment.

Before and during the lumpectomy procedure

Lumpectomy is typically performed on an outpatient basis and rarely requires hospitalization. Patients are usually instructed not to eat or drink for 6 to 12 hours before surgery to ensure the stomach is empty. Prior to the procedure, the surgeon will meet with the patient and any family members to discuss the surgery, questions or concerns.

Lumpectomy is performed with either a local anesthetic (numbs the surgical site) or general anesthetic (puts the patient to sleep temporarily). The surgeon makes an incision large enough to remove both the tumor and a portion (margin) of healthy tissue surrounding the cancer. This helps ensure that no cancer cells are left behind in the breast. Usually, the margin size is around 1 centimeter (less than 1/2 inch). This tissue is sent to a laboratory for analysis by a pathologist. 

In addition, the surgeon typically samples the lymph nodes under the armpit to see if the cancer has spread. Most often, this is done by removing the sentinel lymph node, the first lymph node to which a tumor drains. This is known as a sentinel lymph node biopsy. The sentinel lymph node is found before surgery by injecting a radioactive dye near the tumor. In some cases, cancer of the sentinel lymph node will be obvious, and the surgeon will remove additional lymph nodes to prevent metastasis.

However, in other cases the cancer will not be evident until after a pathologist performs laboratory testing on the sentinel lymph node. If biopsy reveals cancer in the first node, a second surgery can be scheduled to remove additional lymph nodes.

Sentinel lymph node biopsy is now frequently used instead of a lymph node sampling method known as an axillary lymph node dissection. The axillary procedure removes several lymph nodes and involves more extensive surgery. An axillary lymph node dissection may still be performed if a sentinel lymph node biopsy reveals cancer and it becomes necessary to remove additional lymph nodes.

All of the incisions performed during the lumpectomy will be closed with stitches that either dissolve or are removed by a healthcare professional. A drain tube may be placed in the breast to remove build-up of fluid during the recovery time. Adhesive strips may be placed over the incisions to help hold them in place during healing.

The lumpectomy procedure usually takes less than two hours and is frequently performed on an outpatient basis. However, in some cases a hospital stay will be required, particularly for patients who also have several lymph nodes removed. If the patient has received general anesthesia, recovery may take several hours and the patient can be driven home after she is awake and alert.

Because a portion of the breast has been removed, there may be a change in the appearance of the breast. A noticeable scar, dimpling or asymmetry of the two breasts may occur. There also may be a scar under the arm where the lymph nodes have been removed. Unsatisfactory cosmetic results are more likely in women with large tumors or who have tumors that are relatively large compared to breast size.

After the lumpectomy procedure

After the surgery is completed, a bandage will be placed over the incision site. Tubes (drains) may be placed in the breast or underarm area to keep fluid from pooling during healing. These usually remain in place for a week or two and are removed once drainage has been reduced to about 1 ounce a day.

There is usually not an excessive amount of pain with lumpectomy. Patients may experience tightness or strain, especially under the arm. In addition, there may be numbness in the breast tissue and armpit. Some of the feeling in these areas may return, however, for some women, the numbness can persist for months, years or even the rest of their lives.

Before being discharged, patients will be instructed by their physicians and nurses on how to care for themselves in the immediate post-surgery period. Such instructions should include information about:

  • Care for the wound, dressing and drains
  • How to spot an infection or lymphedema
  • Conditions requiring medical attention
  • Exercises and techniques to prevent arm stiffness
  • Clothing options, including bra usage
  • Dietary suggestions to promote healing
  • Drug recommendations for pain and discomfort
  • Limitations on activities

Within a week after surgery, patients return to see their physician for a post-op appointment. During the visit, the surgeon will check the site for healing and will usually review and report the details of the laboratory’s pathology report. Depending on the results of the tests, the physician will discuss options for further treatment. Sometimes, analysis will find cancer at the edge of the piece of tissue removed, which means the lumpectomy did not remove all of the cancer cells along the margin. In such situations, the patient may undergo a second surgery in which more tissue is removed from the breast (re-excision). This second surgery increases the chances that all of the cancer cells have been removed from the area.

After all surgery related to the lumpectomy is finished, a course of radiation therapy is usually necessary to kill any remaining cancer cells or to help ensure that the cancer does not return. In some cases, chemotherapy is also recommended, particularly if cancer was detected in the lymph nodes.

Though chemotherapy may or may not be needed, radiation therapy is almost always required following a lumpectomy. About a month after the initial surgery, radiation treatment sessions begin in an outpatient center. Typically, this will consist of treatments five days a week over six weeks.

Potential risks with lumpectomy

Women who have a lumpectomy usually experience little pain in the breast area, but often feel numbness and pinching or pulling in the underarm area. In some cases, this numbness gradually fades as nerve cells begin to regenerate. However, some patients will experience permanent numbness. Patients with this lack of sensation need to be cautious to avoid injuries such as burns. Daily inspection of a numb area can catch injuries early and avoid infection and other complications.

Other side effects sometimes associated with lumpectomies include:

  • Infection
  • Reaction to anesthesia
  • Blood (hematoma) or fluid (seroma) collecting where the incision was made
  • Swelling of the arm (lymphedema). This happens in about 10 to 30 percent of cases where multiple lymph nodes are removed, according to the American Cancer Society. Patients can be referred to physical or occupational therapy to learn techniques that reduce the swelling, such as compression bandaging of the arm, massage and exercises.

Ongoing research about lumpectomy

Scientists are studying a number of areas related to lumpectomy as a form of breast cancer treatment. Areas of research have focused on advances in surgical procedures, radiation treatment following lumpectomy and methods to help prevent recurrence of the cancer. Studies related to lumpectomy treatment include:

  • Intensity-modulated radiation therapy (IMRT). This radiation system uses higher daily doses of radiation, shortening the treatment period from six to seven weeks to just over four. Additional research and long-term follow-up is needed to fully evaluate the effectiveness of IMRT.
  • Intraoperative radiation. This method of treatment delivers a one-time dose of radiation during breast cancer surgery. It uses a probe to deliver a concentrated dose of radiation directly into the affected area during surgery. Intraoperative radiation will be further studied in clinical trials involving women with small, early-stage breast cancer tumors.
  • Devices to improve treatment following lumpectomy. Scientists are examining technology that may improve treatments. One device, known as the multi-lumen radiation balloon application, is inserted into the breast that will be treated with radiation. It helps remove excess fluid from the breast and may increase the effectiveness of radiation to the tissues. The manufacturer has received approval by the U.S. Food and Drug Administration (FDA) to market the device for therapy following lumpectomy surgery for breast cancer.

Questions for your doctor on lumpectomy

Preparing questions in advance can help patients have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following questions about lumpectomy:

  1. Am I a candidate for a lumpectomy?
  2. How much breast tissue will need to be removed?
  3. Will the procedure be performed as outpatient surgery?
  4. Will I be put to sleep or will it be done under local anesthesia?
  5. How will you know if you have removed all of the cancer cells?
  6. Will you perform another surgery if cancer cells are found?
  7. Is there a chance I will need breast reconstructive surgery?
  8. What type of lymph node sampling will you use?
  9. When will I learn the results of the lymph node analysis?
  10. What can I expect in terms of recovery from the procedure?
  11. What signs indicated the need for medical attention?
  12. How long will it take for my incisions to heal?
  13. What are my restrictions following a lumpectomy?
  14. What can I do to prevent lymphedema?
  15. What cancer treatments will I need after surgery?
  16. Is a lumpectomy as effective as a mastectomy for my cancer?
  17. What are the chances that the cancer will return in my breast?
  18. Do I have a greater chance of breast cancer recurrence with a lumpectomy?
  19. How will I be monitored after my lumpectomy?
  20. Can you recommend a support group?
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