Lumpectomy

A lumpectomy is a surgical procedure to remove a cancerous tumor and a small amount of surrounding healthy tissue from the breast. Also known as breast-conserving surgery or partial mastectomy, its main goal is to remove the cancer while preserving as much of the breast as possible. It is a common treatment for early-stage breast cancer.

What is Lumpectomy?

A lumpectomy is a surgical procedure that removes a cancerous tumor and a small amount of healthy tissue around it from the breast. This surgery is also called breast-conserving surgery (BCS) or partial mastectomy because it aims to remove the cancer while preserving most of the breast's appearance and sensation. It is often followed by radiation therapy.

During a lumpectomy, a surgeon carefully removes the tumor along with a clear margin of healthy tissue surrounding it. This margin is crucial to help ensure all cancerous cells are removed. The amount of breast tissue removed depends on the tumor's size and location, as well as the size of your breast. The goal is to remove the cancer effectively while maintaining the breast's natural shape as much as possible. This procedure is a common treatment option for many people diagnosed with early-stage breast cancer. It allows individuals to avoid a full mastectomy, which involves removing the entire breast. After a lumpectomy, radiation therapy is usually recommended to destroy any remaining cancer cells in the breast and reduce the risk of the cancer returning.

Why it's done

A lumpectomy is primarily performed to treat early-stage breast cancer, including ductal carcinoma in situ (DCIS) and invasive breast cancer. It is an option for individuals whose tumor is small enough relative to their breast size to allow for complete removal with clear margins while preserving most of the breast. This surgery aims to remove the cancerous cells and prevent their spread.

The main reason for a lumpectomy is to remove a breast cancer tumor. It is often recommended for people with early-stage breast cancer, where the cancer has not spread extensively. This includes non-invasive cancers like ductal carcinoma in situ (DCIS), where abnormal cells are confined to the milk ducts, and early-stage invasive breast cancer, where cancer cells have spread beyond the ducts but are still localized. Your doctor will consider several factors when determining if a lumpectomy is suitable for you. These factors include the size and location of the tumor, the size of your breast, and whether there is more than one area of cancer in the breast. If the tumor is large compared to your breast, or if there are multiple tumors in different areas, a lumpectomy might not be the best option, and a mastectomy might be recommended instead. For many people, a lumpectomy followed by radiation therapy offers similar survival rates to a mastectomy, making it a preferred choice for those who wish to preserve their breast.

How to prepare

Preparing for a lumpectomy involves discussing your medical history and medications with your care team, undergoing pre-operative tests, and following specific instructions before surgery. You will likely need to stop eating and drinking for several hours beforehand and arrange for someone to drive you home after the procedure. Your doctor will provide detailed guidance.

Before your lumpectomy, your medical team will provide specific instructions. You will have a consultation with your surgeon to discuss the procedure, potential risks, and what to expect. This is also an opportunity to ask any questions you may have. You should inform your doctor about all medications you are taking, including over-the-counter drugs, vitamins, and herbal supplements. You may be asked to stop taking certain medications, especially blood thinners, for a period before surgery to reduce the risk of bleeding. You will likely undergo several pre-operative tests. These may include blood tests, an electrocardiogram (ECG) to check your heart, and imaging tests like a mammogram or ultrasound to precisely locate the tumor. In some cases, a procedure called wire localization or seed localization might be performed on the day of surgery or the day before. This involves placing a thin wire or a tiny radioactive seed into the breast to guide the surgeon to the exact location of the tumor. On the day of surgery, you will typically be instructed not to eat or drink anything for several hours before the procedure. This is important to prevent complications related to anesthesia. You should also arrange for a trusted friend or family member to drive you home after the surgery, as you will not be able to drive yourself due to the effects of anesthesia.

What happens during

During a lumpectomy, you will receive general anesthesia to ensure you are asleep and pain-free. The surgeon makes an incision in your breast to remove the cancerous tumor along with a small amount of surrounding healthy tissue. Sometimes, nearby lymph nodes are also removed to check for cancer spread. The incision is then closed with stitches.

Once you are under general anesthesia, the surgical team will begin the procedure. The surgeon will make an incision, usually in an inconspicuous area of your breast, to access the tumor. Using the pre-operative localization (if performed), the surgeon carefully removes the tumor and a margin of healthy tissue around it. This healthy tissue margin is sent to a pathologist immediately or shortly after surgery to confirm that no cancer cells are present at the edges of the removed tissue. This is called obtaining "clear margins." In many cases, a sentinel lymph node biopsy is performed at the same time as the lumpectomy. This involves injecting a dye or radioactive tracer near the tumor to identify the first one or two lymph nodes (sentinel nodes) that drain fluid from the breast. These nodes are then removed and checked for cancer cells. If cancer is found in the sentinel nodes, more lymph nodes in the armpit (axillary lymph node dissection) may need to be removed to determine the extent of the cancer's spread. After the tumor and any necessary lymph nodes are removed, the surgeon will reshape the remaining breast tissue to minimize any indentation or change in appearance. The incision is then closed with stitches, which may be dissolvable or require removal later. A small drainage tube might be placed temporarily to collect fluid, though this is not always necessary. The entire procedure typically takes about one to three hours.

Recovery & timeline

Recovery from a lumpectomy usually involves managing pain and swelling, with most people returning home the same day or after a short hospital stay. You will need to limit strenuous activities for several weeks, and full recovery, including healing of the incision and resolution of swelling, can take weeks to months. Your care team will provide specific post-operative instructions.

After a lumpectomy, you will be monitored in a recovery room as you wake up from anesthesia. Most people can go home the same day, though some may require an overnight stay. It's normal to experience some pain, soreness, swelling, and bruising in the breast and armpit area. Your doctor will prescribe pain medication to help manage any discomfort. You might also have a small dressing over the incision. You will receive instructions on how to care for your incision, including when you can shower and how to watch for signs of infection. It's important to avoid heavy lifting, strenuous exercise, and activities that involve repetitive arm movements for several weeks to allow the surgical area to heal properly. Your doctor will advise you on when you can gradually resume your normal activities. Physical therapy or specific exercises may be recommended, especially if lymph nodes were removed, to help restore arm and shoulder mobility and prevent stiffness. Follow-up appointments with your surgeon will be scheduled to check your healing, discuss pathology results (which confirm the type and stage of cancer and whether margins are clear), and plan any further treatments, such as radiation therapy or chemotherapy. While the initial recovery period is a few weeks, it can take several months for all swelling to subside and for you to feel fully recovered.

Risks & side effects

While generally safe, a lumpectomy carries potential risks and side effects. Common ones include pain, swelling, bruising, and temporary numbness around the incision. Less common but possible complications include infection, fluid collection (seroma), bleeding (hematoma), changes in breast shape or size, and, if lymph nodes are removed, arm swelling (lymphedema).

As with any surgery, a lumpectomy has potential risks. Immediately after the procedure, you may experience pain, tenderness, and swelling in the breast and armpit. Bruising around the incision site is also common. Some people report temporary numbness or tingling in the breast or arm due to nerve irritation or damage during surgery. These symptoms usually improve over time. Less common complications include infection at the surgical site, which may require antibiotics. A seroma, which is a collection of clear fluid under the skin, can sometimes form and may need to be drained by your doctor. Similarly, a hematoma, a collection of blood, can also occur. While efforts are made to preserve breast shape, a lumpectomy can sometimes lead to changes in the breast's appearance, such as a dimple or a slight difference in size compared to the other breast. If lymph nodes are removed from your armpit, there is a risk of developing lymphedema. This is a chronic swelling of the arm, hand, or chest wall due to impaired lymphatic drainage. The risk of lymphedema is higher with axillary lymph node dissection compared to sentinel lymph node biopsy. Your medical team will discuss these risks with you and provide guidance on how to manage any side effects.

Success rate

For many people with early-stage breast cancer, a lumpectomy followed by radiation therapy offers a similar long-term survival rate to a mastectomy. Studies show that when combined with radiation, the risk of cancer returning in the same breast (local recurrence) is comparable to that after a mastectomy, making it an effective breast-conserving treatment option.

The success of a lumpectomy is often measured by its ability to remove cancer effectively and prevent its recurrence, while also preserving the breast. For individuals with early-stage breast cancer, a lumpectomy combined with radiation therapy is considered as effective as a mastectomy in terms of overall survival. This means that people who undergo lumpectomy and radiation have similar chances of living for a certain period as those who have a mastectomy. Research, including reviews from the Cochrane Library, indicates that there is no significant difference in overall survival or disease-free survival between breast-conserving surgery (lumpectomy) followed by radiation and mastectomy for early breast cancer. The addition of radiation therapy after a lumpectomy is crucial. Without radiation, the risk of local recurrence (cancer returning in the treated breast) is significantly higher. With radiation, the local recurrence rates are greatly reduced and become comparable to those seen after a mastectomy. Your specific prognosis and success rate will depend on various factors, including the stage and type of your cancer, whether the margins were clear, and if you receive all recommended follow-up treatments, such as radiation therapy or chemotherapy. Your oncology team will discuss your individual success rates based on your specific diagnosis.

Frequently asked questions

Will I need radiation after a lumpectomy?

In most cases, yes. Radiation therapy after a lumpectomy is usually recommended to destroy any remaining cancer cells in the breast and significantly reduce the risk of the cancer returning in the same breast.

How long does a lumpectomy surgery take?

A lumpectomy procedure typically takes about one to three hours, depending on the size and location of the tumor and whether a lymph node biopsy is also performed.

Will my breast look different after a lumpectomy?

You may notice some changes in your breast's appearance, such as a slight indentation, dimple, or difference in size compared to your other breast. Surgeons try to minimize these changes, but some alteration is common.

When can I return to work after a lumpectomy?

Most people can return to light work within a few days to a week after a lumpectomy. However, if your job involves strenuous physical activity, you may need to take more time off, typically several weeks.

Is a lumpectomy painful?

You will not feel pain during the surgery due to general anesthesia. Afterward, it's normal to experience some pain and soreness, which can be managed with prescribed pain medication. Discomfort usually subsides within a few days to weeks.

What are "clear margins" and why are they important?

"Clear margins" means that no cancer cells are found at the edges of the tissue removed during surgery. This is important because it indicates that all visible cancer has been removed, reducing the chance of recurrence. If margins are not clear, further surgery might be needed.

Sources

• MedlinePlus — Lumpectomy
• Mayo Clinic — Lumpectomy
• Cochrane Library — Lumpectomy