Lumpectomy
Lumpectomy
July 21, 2008

Lumpectomy is surgery in which only the tumor and some surrounding tissue is removed. On the following pages, you can learn more about lumpectomy surgery, lumpectomy followed by radiation therapy, what to expect from lumpectomy surgery, and questions to ask your surgeon.

What is Lumpectomy?

Lumpectomy is the removal of the breast tumor (the "lump") and some of the normal tissue that surrounds it. Lumpectomy is a form of “breast-conserving” or "breast preservation" surgery. There are several names used for breast-conserving surgery: biopsy, lumpectomy, partial mastectomy, re-excision, quadrantectomy, or wedge resection. Technically, a lumpectomy is a partial mastectomy, because part of the breast tissue is removed. But the amount of tissue removed can vary greatly. Quadrantectomy, for example, means that roughly a quarter of your breast will be removed. Make sure you have a clear understanding from your surgeon about how much of your breast may be gone after surgery and what kind of scar you will have.

Lumpectomy Plus Radiation

Most people receive 5 to 7 weeks of radiation therapy shortly after lumpectomy in order to eliminate any cancer cells that may be present in the remaining breast tissue. The combination of lumpectomy and radiation therapy is commonly called breast-conserving therapy. If chemotherapy is also part of the plan, radiation therapy happens after chemotherapy.

Two studies published in the October 17, 2002 issue of the New England Journal of Medicine showed that women with small breast cancers (under 4 centimeters) treated with lumpectomy plus radiation therapy were just as likely to be alive and disease-free 20 years later as women who had had mastectomies.

It’s important to know that recurrence can still happen with lumpectomy plus radiation. In the studies mentioned above, 14% of the women in one study and 9% of the women in the other study who had lumpectomy plus radiation had a recurrence in the same breast. However, local recurrences (confined to the breast area) after lumpectomy can be treated effectively with mastectomy, and these women were still disease-free 20 years after their original lumpectomies and recurrence treatments.

Is Lumpectomy Plus Radiation Right for You?

While lumpectomy plus radiation is an excellent option for many women with breast cancer, it's not the best treatment for everyone.

Lumpectomy plus radiation may NOT be right for you under the following circumstances:

You have already had radiation to the same breast for an earlier breast cancer. Radiation cannot be given twice to the same area.
You have extensive cancer in the breast or have two or more separate areas of cancer in the same breast. If cancer is extensive or in multiple areas, a mastectomy may be required.
You have a small breast and a large tumor and removing the tumor would be extremely disfiguring.
Your surgeon has already made multiple attempts to remove the tumor with lumpectomy, but has not been able to completely remove the cancer and obtain clear margins.
You have a connective tissue disease, such as lupus or vasculitis, which would make you sensitive to the side effects of radiation.
You are pregnant. If you're pregnant, it's not save to have radiation therapy.
You are not willing to commit to the daily schedule of radiation therapy, or distance makes it impossible.
You believe you would have greater peace of mind with a mastectomy.

Lumpectomy: What to Expect

Before lumpectomy surgery
In the hospital on the day of surgery, you’ll change into a hospital gown and wait in a preoperative holding area.

If the tumor cannot be seen or felt, the surgeon will use a procedure before surgery to locate and mark the tumor using mammogram or ultrasound.

Your surgeon or a nurse may draw markings on your breast that show where the incision will be made. Usually this is done with a felt-tip marker.

You will be taken into the anesthesia room, where a nurse will insert an intravenous infusion (IV) line into your hand or arm and tape it into place. Soon after this, you’ll be given relaxing medication through the IV line. Most people who have lumpectomy choose to have a local anesthetic to numb the surgery area, but some have general anesthesia.

What happens during lumpectomy surgery
The lumpectomy surgery itself should take about 15-40 minutes.

Your surgeon will probably operate with a kind of electric scalpel that uses heat to minimize bleeding (an electrocautery knife). Most surgeons use curved incisions (like a smile or a frown) that follow the natural curve of your breast and allow for better healing. If the tumor can be seen or felt, the surgeon will remove it along with a rim of healthy tissue around it.

Sometimes, but not always, a rubber tube called a drain will be surgically inserted into your breast area or armpit to collect excess fluid that can accumulate in the space where the tumor was. The drain is connected to a plastic bulb that creates suction to help remove fluid. Finally, your surgeon will stitch the incision closed and dress the wound.

After lumpectomy
You’ll be moved to the recovery room after lumpectomy surgery, where staff will monitor your heart rate, body temperature, and blood pressure. Staying overnight in the hospital is not usually necessary with lumpectomy, unless you're also having lymph nodes removed.

As you start to feel more awake, your surgeon or nurse will give you information about recovering at home:

Taking pain medication: You may be given pain medication in the recovery room, and your surgeon will probably give you a prescription to take with you when you leave the hospital. You might want to get it filled on your way home or have a friend or family member get it filled for you as soon as you are home. You may not need the medication, but it’s good to have it on hand in case you do.
Caring for the bandage (dressing) over your incision: Ask your surgeon how to take care of the lumpectomy bandage. Sometimes, the surgeon will ask that you wait until your first follow-up visit so that he or she can remove the bandage.
Caring for a surgical drain: If you have a drain in your breast area or armpit, the drain might be removed before you leave the hospital. Sometimes, however, a drain stays inserted until the first follow-up visit with the doctor, usually 1-2 weeks after surgery. If you’re going home with a drain inserted, you’ll need to empty the fluid from the detachable drain bulb a few times a day. Make sure your surgeon gives you instructions on caring for the drain before you leave the hospital.
Stitches and staples: Most surgeons use sutures (stitches) that dissolve over time, so there's no longer any need to have them removed. But occasionally, you'll see the end of the suture poking out of the incision like a whisker. If this happens, your surgeon can easily remove it. Surgical staples — another way of closing the incision — are removed during the first office visit after surgery.
Exercising your arm: Your surgeon may show you an exercise routine you can do after surgery to prevent arm and shoulder stiffness on the side where you had the lumpectomy. Usually, you will start the exercises the morning after surgery. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.
Recognizing signs of infection: Your surgeon should explain how to tell if you have an infection in your incision and when to call the office.
At-home recovery from lumpectomy
You’ll recuperate at home for a few days after lumpectomy surgery. Here are some guidelines to follow:

Rest. When you get home from the hospital, you might be fatigued from the experience. Allow yourself to get enough rest so that you can return to your normal routine in a few days. There are a number of ways to manage fatigue.
Take pain medication as needed. You might feel a mixture of numbness and pain around the surgery area in the breast (and the armpit incision, if you had lymph nodes removed). If you feel the need, take pain medication according to your doctor’s instructions. Learn more about managing pain and armpit discomfort.
Take sponge baths until your doctor has removed your drains and/or sutures. You can take your first shower when your drains and any staples or sutures have been removed. A sponge bath can refresh you until showers or baths are approved by your doctor.
Wear a good sports or support bra. You’ll want a supportive bra to wear both day and night for a while to minimize any movement that could cause pain. If you have larger breasts, you may find it more comfortable to sleep on the side that has not been operated on, with your healing breast supported by a pillow in front of you.
Begin doing arm exercises. The morning after surgery, begin doing arm exercises if your surgeon has advised you to do so.
Weeks and months after lumpectomy
As nerves regrow, you may feel a weird crawly sensation, you may itch, and you may be very sensitive to touch. Your discomfort may go away by itself, or it may persist but you adapt to it. NSAIDs (pronounced EN-seds) such as acetaminophen and ibuprofen usually can address the pain related to this type of nerve injury. Opioids (pronounced OH-pee-oydz) also can be used to treat this type of pain.

Re-excision Lumpectomy

After lumpectomy, all the tissue removed from the breast is examined carefully to see if cancer cells are present in the margins — the normal tissue surrounding the tumor. If cancer cells are found in the margins extending out to the edge of the breast tissue that was removed, your surgeon will perform additional surgery (called re-excision) to remove the remaining cancer.

Re-excision lumpectomy, or simply re-excision, means surgically re-opening the lumpectomy site to try to remove a larger margin of cancer-free tissue. When cancer cells are found close to the edge of the lumpectomy margin, re-excision is necessary to ensure that all the cancer is gone. You may hear your surgeon refer to re-excision as "clearing the margins."

Lumpectomy Risks

Like all surgeries, lumpectomy carries certain risks:

Loss of sensation: There is usually some numbness and loss of sensation in part of the breast after lumpectomy, depending on the size of the lump removed. Some or most of this ability to feel can return.
Breasts that don’t match exactly: Your breasts may not match precisely in size and shape after surgery. This is because removing breast tissue during surgery usually makes the affected breast appear smaller. You may not know this right away, because swelling in response to surgery may make your breast appear temporarily larger.

Questions to Ask Your Surgeon About Lumpectomy

Here are some questions to ask your surgeon as you plan for lumpectomy surgery:

How many times have you performed lumpectomy?
What are the risks of lumpectomy?
How should I prepare for surgery?
How long will surgery take?
How much tissue will be removed?
Will you remove any underarm lymph nodes (axillary node dissection) along with the lump?
Will I have anesthesia? If so, what kind?
Will I need blood transfusions? Should I donate my own blood before surgery?
How will my breast look after lumpectomy?
Will I need to stay in the hospital after surgery?
How long will it take to recover?
Are there any precautions I should take as I recover? Will you give me written instructions to follow?
Are there exercises I need to do after surgery?
When can I return to my normal routine and activities?
Will I be at risk for lymphedema after surgery?

Lumpectomy as Part of Experimental Treatment

Lumpectomy can sometimes be a part of treatment that is directed only to the tumor area. This type of treatment is still considered "non-standard" or "experimental" for most people diagnosed with early breast cancer. The current standard of care is to treat whole breast with radiation after lumpectomy. However, for people who fit certain criteria, two treatment options may be available for partial-breast treatment:

Lumpectomy plus internal radiation: In this experimental treatment, lumpectomy is followed by “internal” radiation, which involves implanting small pieces of radioactive substances, called “seeds,” into the breast in a tiny tube or balloon device. This way, treatment is concentrated only to the area where the tumor was. After treatment, there is close medical follow-up and surveillance of the remainder of the breast tissue with regular mammography and physical examination.
Lumpectomy and close observation: This experimental treatment means having only lumpectomy and no radiation. The remainder of the breast tissue is then closely watched with regular mammography and physical examination.
Who is a candidate for treatment to partial-breast treatment?
Partial-breast treatments such as lumpectomy and internal radiation may be considered for people with a relatively small, non-invasive cancer that has all three of the following characteristics:

the cancer cell formation is low-grade or “non-comedo”
the tumor has been completely removed (resected)
the removed tissue had wide (about 1 centimeter), clear margins of resection
Partial-breast treatment may be offered in a clinical trial or on an individual basis by your physician. Occasionally, partial-breast treatment may be offered to people with a relatively small, low-grade, invasive cancer that has been completely removed (resected) with wide, clear margins of about 1 centimeter. Usually, this treatment is offered within the context of a clinical trial.

Getting Your Pathology Results After Lumpectomy

In the days following lumpectomy, you’ll receive a pathology report. This report will explain the characteristics of the breast cancer. The size of the cancer as well as other diagnostic factors, such as tumor margins and hormone receptor status, will help you and your doctor to decide on a treatment plan that’s appropriate for you.
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