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Lumpectomy Procedure

A lumpectomy is a surgical procedure used to remove abnormal breast tissue that may be cancerous. The surgeon also removes a small margin of healthy tissue around the tumor. This precaution helps ensure all the cancer cells are gone. In some lumpectomy procedures, the surgeon may also remove lymph nodes from beneath the patient’s arm to ensure cancer does not spread.

Lumpectomy procedures are breast-conserving surgeries. The alternative to a lumpectomy is a mastectomy, which removes the entire breast. A lumpectomy only removes the affected portion of the breast, retaining most of the original tissue. Other names for a lumpectomy procedure include

  • Wedge resection
  • Partial mastectomy
  • Tylectomy
  • Segmental excision
  • Quadrantectomy
  • Wide excision biopsy

Determining candidacy for lumpectomy

About half of the women with a breast cancer diagnosis are good candidates for a lumpectomy. Several factors influence candidacy, including the size, type, and shape of the tumor. The surgeon also considers breast size when recommending a lumpectomy.

The stage of the cancer is another factor in determining whether a lumpectomy is appropriate. The staging system is complex; it essentially rates cancer according to size and how far it has spread to other areas. Studies show that combining lumpectomy with radiation treatment is just as effective as a complete mastectomy for early-stage cancers.

Avoiding lumpectomy for certain patients

Some women should not have a lumpectomy because of existing health conditions or the extent of their cancer. Some of these conditions include

  • Multiple tumors in the same breast or extensive cancer – A lumpectomy targets and removes a specific area. If the cancer is in more than one location, the surgeon cannot remove it via a single incision. Other therapies are recommended for patients with these issues.
  • Tumors that involve rapid growth or attach to the chest wall or skin – These issues make full removal of the tumor problematic. Since there is little guarantee that the entire tumor can be removed, the surgeon may opt for a more extensive procedure.
  • Pregnancy – Radiation therapy follows most lumpectomy procedures. The radiation can harm the developing baby.
  • Large tumors – If the tumor is five centimeters or more in diameter, its removal can cause drastic breast disfigurement. However, the doctor may first recommend a course of chemotherapy or endocrine therapy to shrink the tumor to a manageable size.
  • Preexisting conditions – The risk of complications from radiation increases for women who have certain diseases. They include connective tissue diseases like scleroderma and lupus, skin conditions like psoriasis, and immune conditions like sarcoidosis.
  • Previous chest radiation – If a woman has had chest radiation to treat a disease or following a previous lumpectomy, she cannot have more radiation. A mastectomy is the recommended course of treatment in these situations.

Weighing the risks of a lumpectomy breast procedure

The risks of a lumpectomy are similar to those of any surgical procedure. If the patient is asleep during the procedure, there is a low risk of allergic reaction to the anesthesia. Temporary swelling, pain, and tenderness are common. Other risks include scarring, bleeding, and infection.

Numbness

Most women experience some loss of sensation in their breast after a lumpectomy. The degree of these effects depends on the amount of tissue removal. Some of the ability to feel can return as the breast heals.

Asymmetrical breasts

The affected breast may be smaller after surgery. However, this may not be apparent until the swelling goes down. If the breast is significantly different in size or shape, the patient may be a candidate for reconstructive surgery. Doctors recommend waiting at least 6-12 months post-surgery before having reconstructive work.

Radiation therapy risks

Radiation can cause several side effects, including fatigue, nausea, and hair loss. Patients may also experience a loss of appetite. Skin redness or rashes may occur in the treated area.

Risks associated with lymph node removal

Lymph node removal increases the risk of complications. Since the surgeon removes nodes via the armpit, the patient may lose feeling in that area. Numbness, tingling, or heightened skin sensitivity may also occur. An inflammatory condition called phlebitis can develop in the arm vein. Another potential complication is range of motion loss due to nerve damage.

About 2-10 percent of women develop lymphedema in the affected arm. This condition causes swelling when lymph fluid builds up in the arm. It can occur at any time, even years after surgery. Symptoms range from mild to severe. Treatment can ease discomfort, but lymphedema is a chronic condition that requires ongoing care. Permanently avoiding tight things on the arm, such as blood pressure cuffs, tight sleeves, or tourniquets, can help prevent lymphedema.

Preparing for your lumpectomy

If you cannot see or feel the tumor in your breast, a radiologist will mark the tumor’s location with a wire-localization or radioactive seed localization procedure. Using a mammogram, ultrasound, or breast MRI, the radiologist inserts a thin wire or radioactive seed into the tumor location. The surgeon will remove the marker along with the tumor during surgery.

Getting ready for surgery

If you are not already wearing a hospital gown, a nurse will ask you to change. The surgeon or a nurse will use a felt-tip marker to show the incision location. You will also have an intravenous (IV) line inserted into your hand or arm. The nurse uses the IV line to give you medication that will help you relax.

Anesthesia options

Some women opt to have a local anesthetic. This means that only the surgery area is numb during the operation, and the patient is awake. Others choose general anesthesia, which means they are asleep during the operation. The type of sedation used for your procedure depends on how much tissue the surgeon must remove.

During the lumpectomy surgery procedure

First, the surgeon cleans the breast, chest, and upper arm area where the lump will be removed. He or she makes an incision along the previously marked lines and removes the tumor, along with a margin of healthy tissue. The operating room staff saves and sends the tumor and surrounding tissue to a pathologist. The pathologist will examine the tissue to make sure the surgeon removed all cancerous or abnormal cells.

Next, the surgeon stitches the wound closed and bandages it. If necessary, he or she may insert a drain into the wound to remove excess fluid while the wound heals. The drain tube leads to a plastic bulb that uses suction to remove the fluid. The bulb also serves as a holding area for the fluid. If you have a drain, the surgeon will give you care instructions to use until it is time to remove it.

Lymph node removal

The surgeon may remove underarm lymph nodes during surgery to determine whether the cancer is spreading. There are two options for lymph node removal.

  • Axillary node dissection involves removing several lymph nodes from the armpit on the same side as the tumor. The surgeon may use this procedure when a pre-surgery lymph node biopsy indicates an elevated risk of cancer in the lymph nodes.
  • Sentinel lymph node biopsy is less invasive. In this procedure, the tumor is injected with blue dye or a radioactive substance. This helps the surgeon locate the sentinel nodes, with are the first lymph nodes into which the tumor drains. These nodes are removed and tested; if they are cancer-free, the rest of the lymph nodes are much less likely to be cancerous. If the tests indicate cancer, the doctor may recommend removal or radiation therapy.

Recovering from a lumpectomy

If you had an outpatient procedure such as a lumpectomy or sentinel node biopsy, you should be able to return home the same day. If you had an axillary node dissection, you may stay in the hospital for a couple of days. You will probably feel tired for a few days. Give your body plenty of time to rest and heal. Ask friends or family members to help you with housework and take care of pets or young children for the next couple of weeks.

Pain management

Pain levels depend on the extent of your procedure, personal tolerances, and how well you follow the surgeon’s post-operative instructions. You should not lift anything that weighs over five pounds for the next week. The doctor may also limit other activities.

Using an ice pack over the incision for the first 24 hours can reduce pain and swelling. Over-the-counter pain relievers like acetaminophen may also help. Your doctor may give you a prescription for pain medicine. Fill it as soon as possible after you leave the surgical center. You may not need it, but it is better to have it on hand in case you do.

Protecting range of motion

The nurse should demonstrate exercises you can use to reduce pain and stiffness in the arm and shoulder closest to the surgical site. You should also receive written instructions with illustrations. In most cases, you will begin the routine the morning following your surgery. However, you may need to wait to do some of them until your drain is removed. Talk to the surgeon to determine which exercises are right for you. 

Follow-up visit

The surgeon will likely schedule a follow-up visit 1-2 weeks after your surgery. He or she will remove any staples used to close your incision and take out your drain if you had one. You may also discuss test results and further treatment options.

At-home care

Most women can resume normal activities within a few days. However, this depends on the extent of your surgery. It can take up to two weeks to recover. Wear a well-fitting support bra to minimize breast movement and reduce pain and swelling. You should not take a shower until after your stitches are gone and your drain is removed. Until then, you may use sponge baths to stay clean.

Increased pain or soreness after three days could be a sign of infection. Contact the surgeon if you recognize signs of infection such as foul odors, pus, or hot, red skin.

Taking the next steps after a lumpectomy

Most women begin radiation therapy about a month after surgery. The therapy usually takes place for half an hour each day over a six-week period. Some women who have small tumors may be eligible for localized breast irradiation. It takes place twice a day over a five-day period. An oncologist or another specialist can help you determine which option is best for your situation.

Getting test results

Testing of the tumor and surrounding tissue can indicate one of two outcomes. Clear margins mean the tumor has not spread, and all the problematic tissue is gone. Positive margins indicate that the surgeon did not remove all the cancerous or abnormal tissue. Further treatment options may include more surgery, chemotherapy, or hormonal or endocrine therapy to remove cancer.

The outlook for patients who have a lumpectomy and follow-up radiation treatment are good. Only about 5 - 10 percent of patients have cancer come back after five years. After 10 years, 85 - 90 percent of patients are still cancer-free.

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