Lumpectomy

A lumpectomy, also known as breast conserving surgery, is surgery to remove a breast cancer from the breast along with some surrounding tissue.

If the breast cancer can be seen on imaging tests but the doctor can’t feel it when examining you, a wire localization will be done before the surgery. This involves a radiologist using a mammogram or ultrasound to place a needle (or needles) in or near the abnormal breast area in order to help the surgeon know where the cancer is so it can be removed.

Most of the time a lumpectomy is performed as an inpatient procedure. You’ll be given general anesthesia (you will be asleep, but pain-free). The procedure takes about 1 hour.

The surgeon makes a small cut on your breast and removes the cancer and some of the normal breast tissue around it. The sample is sent to a pathologist who examines it and makes sure all the cancer has been removed. When no cancer cells are found near the edges of the tissue removed it’s known as a clear margin. Your surgeon may also remove lymph nodes in your armpit to see if cancer has spread to the lymph nodes.

Sometimes, small metal clips will be placed inside the breast to mark the area of removal so it can be seen on future mammograms and to help guide radiation therapy when needed. The surgeon will close the skin with stitches. These may dissolve or need to be removed later. A drain tube may be placed to remove extra fluid. Your doctor will then send the lump to a laboratory for more testing.

WHY THE PROCEDURE IS PERFORMED

Surgery to remove a breast cancer is most often the first step in treatment. The choice of which surgery is best for you can be difficult. It may be hard to know whether lumpectomy or mastectomy is best, and you and your health care providers should decide together.

Lumpectomy is often preferred for smaller breast lumps as it’s a smaller procedure, but has about the same chance as a mastectomy of curing breast cancer. On the other hand, mastectomy to remove all breast tissue may be performed if the area of cancer is too large to remove without deforming the breast.

You and your doctor should consider:

The size of your tumor

Where it is in your breast

If there is more than one tumor

How much of the breast is affected

The size of your breasts

Your age

Family history

General health, including whether you have reached menopause

RISKS

Risks for any surgery include:

Bleeding

Infection

Reactions to medications

The appearance of your breast may change after surgery. You may notice dimpling, a scar, or a difference in shape between the two breasts, and you may also have numbness in the breast area. You may also need another procedure to remove more breast tissue if tests show the cancer is too close to the edge of the tissue already removed.

BEFORE THE PROCEDURE

Always tell your doctor or nurse:

If you could be pregnant

If you could be pregnant

During the days before the surgery:

Ask your doctor which drugs you should still take on the day of the surgery

You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot

Always try to stop smoking. Your doctor or nurse can help

On the day of the surgery:

Follow your doctor's instructions about eating or drinking before surgery

Take the drugs your doctor told you to take with a small sip of water

Your doctor or nurse will tell you when to arrive for the procedure

AFTER THE PROCEDURE

The recovery period is very short for a simple lumpectomy. You should have little pain. If you do feel pain, you can take pain medicine, such as acetaminophen.

The skin should heal in about a month, and you’ll need to take care of the surgical cut area. Change dressings as your doctor or nurse tells you to. Watch for signs of infection when you get home (such as redness, swelling, or drainage). You may also need to empty a fluid drain a few times a day for 1 to 2 weeks. Your doctor will remove the drain later.

Most women can go back to their usual activities in a week or so. Avoid heavy lifting, jogging, or activities that cause pain in the surgical area for 1 to 2 weeks.

OUTLOOK (PROGNOSIS)

The outcome of a lumpectomy for breast cancer depends mostly on the size of the cancer and if it’s spread to the lymph nodes underneath your arm. A lumpectomy for breast cancer is usually followed by radiation therapy and additional treatment such as chemotherapy, hormone therapy, or both.

Women usually don’t need breast reconstruction after lumpectomy, however if the breast is misshaped after the surgery, your surgeon may recommend some contouring to create a full breast.