Lumpectomy for Breast Cancer

Overview
Lumpectomy, also known as breast-conserving or breast-sparing surgery, wide local excision, or partial mastectomy, is surgery to remove a breast cancer tumor along with some of the normal breast tissue that surrounds it. The goal in removing the normal breast tissue is to create clear margins and help ensure that no cancer cells remain in your breast. One or more lymph nodes near the tumor or in the armpit may also be removed during a lumpectomy. Unlike mastectomy, lumpectomy removes only a portion of the breast. The amount and location of the breast tissue removed depend on the type, size and location of your tumors.

Lumpectomy may be performed to confirm or to rule out a diagnosis of breast cancer. It may also be a treatment option for women with early-stage breast cancer or locally advanced breast cancer. Lumpectomy is most frequently recommended as a treatment for breast cancer when there is only one tumor in the breast, and the tumor is less than five centimeters in diameter. When used as a treatment, lumpectomy is most frequently followed by radiation therapy in order to lower the risk that cancer might recur.

Lumpectomy is not recommended for pregnant women, women who have already had a course of radiation to the same breast, or women with other conditions such as lupus, scleroderma, or vasculitis that make the side effects of radiation harder to tolerate. Lumpectomy may not be advisable in cases where tumors are extensive in the breast; if you have tumors in more than one area in the breast; if previous lumpectomies have failed to remove the tumor; or if you have small breasts and a large tumor, which could make the scars more disfiguring. Whether or not lumpectomy is the best choice may also depend on where the tumor is located. For instance, if it is directly beneath the nipple, lumpectomy could also be more disfiguring.

What does it involve?
Ask your doctor for details about how much breast tissue will be removed, where it will be, and what kind of scar you will have. Make sure you understand all of your options, and the risks and benefits associated with each.

Lumpectomy is often an outpatient procedure, but more extensive surgeries may necessitate one or two days of hospital stay for monitoring. Lumpectomy may be done under local anesthesia or general anesthesia.

Lumpectomy procedures differ in part according to whether lymph nodes are also removed, and if so, where the lymph nodes are located. The surgeon may remove one or two lymph nodes, called sentinel nodes, located nearest the tumor. This procedure is called sentinel node biopsy. These nodes will be tested for cancer cells, and if the test is positive, the surgeon may remove several lymph nodes from the armpit on the same side as the tumor in a procedure is called axillary lymph node dissection. If you undergo sentinel node biopsy, the surgery will likely be outpatient. If you undergo axillary node biopsy, you will likely need to stay overnight.

On the day scheduled for surgery, you will arrive at the hospital and change into a gown. Before surgery, your surgeon may give you an ultrasound or mammogram in order to pinpoint the location of the tumor. They may mark the location of the tumor on your breast using a felt-tip marker, or, if your tumor is too small to be felt with the fingers, use another marking procedure that involves inserting a needle or very thin wire into your breast. You will then be taken to an anesthesia room and given an intravenous infusion (IV) and some medication to relax you. Depending on what type of lumpectomy you’re receiving, you may receive general or local anesthetic at this time.

The surgery itself will likely take less than one hour. Surgeons usually make curved incisions that follow the contour of the breast. This makes healing easier and minimizes scarring. The surgeon may inject a small amount of blue dye or radioactive material near the nipple in order to pinpoint which lymph nodes are involved with the tumor and need to be removed. At the end of the surgery, the surgeon may insert a rubber drainage tube into the spot where the tumor was in order to help drain excess fluid. The drainage tube may be removed before you leave the hospital, or within one to two weeks after your surgery. The surgeon may also place a small metal clip inside your breast at the site of the tumor removal. This will make the area easier to find during future mammograms and also in case you receive radiation therapy. Then the surgeon will close the wound with stitches or staples.

After lumpectomy surgery, you will be sent to a recovery room. Depending on the extent of your surgery, you will spend either a few hours or a night or two. During this time, your blood pressure, heart rate and temperature will be monitored. You will be discharged when your condition is stable. Your surgeon will provide instructions on how to care for your wound and drainage tube, how to exercise your arm so it does not become stiff, and how to recognize signs of infection. You will be given prescriptions for medication to help manage your pain. Make sure you understand the instructions, and do not be afraid to ask questions.

While you finish your recovery at home, get plenty of rest. Take pain medications as needed. It is best to wear a sports bra or other good, supportive bra both day and night in order to minimize painful movements. Carefully monitor for signs of complications. Call your doctor immediately if you experience swelling or redness in the arm or hand on the side you had the lumpectomy. Avoid showers and baths and take sponge baths until your doctor has said you can resume your regular bathing routine.

The tissue removed during the lumpectomy will be sent to the lab for testing. It may take one or two weeks to receive results. If cancerous tumors are found during the lumpectomy, surgery will likely be followed by radiation therapy and may be followed by a course of chemotherapy or specific hormone drugs like Tamoxifen or targeted therapies such as Trastuzumab.

Lumpectomy will change the appearance of your breast to some degree. The shape may change. There will be some scarring. Your breast may be smaller and firmer. There will also be some numbness. Some women consider reconstructive surgery after lumpectomy.

Intended Outcomes
When used as a treatment, lumpectomy can remove tumors while preserving as much of the healthy breast tissue, as well as the shape of the breast, as possible. Lumpectomy can also help diagnose or rule out breast cancer in cases where diagnosis is uncertain.

Results
In a summary of clinical trials involving at least 150 participants and with at least 10 years of follow-up, lumpectomy with radiation was found to be equivalent in effectiveness with mastectomy at treating early breast cancer in terms of overall survival. The summary was updated in January 2014.

Constraints
After lumpectomy, you can expect some pain during recovery and some numbness at the site of the incision. There will be some scarring, and the shape of your breast may change.

Since radiation therapy is often performed after lumpectomy, you may need to be medically able to receive radiation and tolerate its side effects.

The chances of breast cancer recurring after lumpectomy and radiation are very slightly higher than if you receive a mastectomy.

Any type of surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.