Lumpectomy

Overview

Lumpectomy, alternatively known as partial mastectomy or segmentectomy, is a surgical procedure for treating breast cancer that involves removing a tumor while preserving the overall structure of the breast. During this operation, the surgeon excises the cancerous or abnormal tissue along with a small margin of surrounding healthy tissue to ensure complete removal of the affected area.

This approach, also referred to as breast-conserving surgery or wide local excision, entails removing only a portion of the breast, as opposed to a mastectomy where the entire breast tissue is removed. Medical professionals may also use terms like excisional biopsy or quadrantectomy to describe lumpectomy.

Typically recommended for early-stage breast cancer, lumpectomy serves both therapeutic and diagnostic purposes. In cases where cancer is confirmed, lumpectomy is often followed by radiation therapy to the breast to diminish the likelihood of cancer recurrence.

Various types of lumpectomy include:

• Excisional biopsy: Primarily a diagnostic procedure, the surgeon removes the tumor for biopsy, and a pathologist examines the tissue to determine its cancerous or benign nature.
• Wide local excision: This cancer treatment surgery involves removing the tumor along with a small margin of adjacent healthy tissue. The pathologist assesses the margin to confirm the absence of cancer cells, indicating a successful removal of the cancer.
• Quadrantectomy: This procedure entails the removal of approximately a quarter of the breast, including the tumor, a margin of healthy tissue, and the region containing milk ducts.
• Re-excision of margins: Following a wide local excision, if test results reveal signs of cancer cells in the margin of healthy tissue, a subsequent surgery is performed to reopen the site and remove additional tissue, ensuring the complete eradication of cancer cells.

Reasons for undergoing the procedure

Your doctor might suggest a lumpectomy if it can effectively eliminate the cancer with minimal risk of recurrence while maintaining the appearance of your breast. You could be a suitable candidate for a lumpectomy if:

• The cancer is localized to a specific area of your breast.
• The tumor is relatively small in comparison to the overall volume of your breast.
• Adequate remaining tissue is anticipated, enabling the reshaping of your breast post-tumor removal.
• Your health and schedule permit the completion of radiation therapy afterward.

Risks

While lumpectomy is a commonly performed and generally safe surgery, as with any surgical procedure, there are potential risks and complications, including:

• Infection near the incision site.
• Accumulation of clear fluid (seroma).
• Accumulation of blood (hematoma).
• Scarring resulting from radiation exposure (radiation fibrosis).
• Bruising and swelling in the arm or hand closest to your breast (lymphedema).
• Alteration in the form and aesthetic of the breast, especially when a substantial portion has been excised.
• Occasional shooting pain in the arm, armpit, or chest, typically resolving within a few weeks.

It’s important to note that the appearance of your breast may undergo changes during the healing process. If you find yourself dissatisfied with the outcome, consultation with a cosmetic surgeon may be an option to explore.

Before the procedure

Before your lumpectomy, schedule a meeting with your surgeon a few days in advance. Prepare a list of questions to ensure you cover all your concerns and understand the procedure and its associated risks.

During this appointment, your surgeon will provide instructions regarding pre-surgical restrictions and other essential details. Typically, lumpectomies are outpatient procedures, allowing you to return home the same day.

Ensure to inform your surgeon about any medications, vitamins, or supplements you’re taking, as certain substances may interfere with the surgery.

To adequately prepare for your lumpectomy:

• Cease taking aspirin or other blood-thinning medications as instructed by your doctor, typically a week or more before the surgery to minimize bleeding risks.
• Understand your treatment options fully. Clarify why breast-conserving surgery is recommended for you and grasp the potential post-operative requirements such as radiation or reconstructive surgery.
• Comprehend medication and fasting instructions provided by your provider. Adhere to guidelines regarding which medications, herbs, vitamins, and supplements are safe to consume and when to stop eating or drinking before the surgery.
• Arrange for someone to accompany you. This individual can offer support and will be required to drive you home post-surgery. Additionally, having another person present ensures that all postoperative instructions are comprehensively understood, especially considering the lingering effects of anesthesia.

During the procedure

On the day of your surgery:

• A radiologist, a doctor specialized in imaging, will typically use ultrasound or mammography to pinpoint the tumor within your breast. They will insert a small chip or wire to mark the precise location for the surgeon.
• You will be administered medication to prevent pain. General anesthesia, inducing sleep, is commonly used, or you may receive moderate sedation with local anesthesia to numb the tumor site.
• The surgeon will utilize these markers to excise the tumor along with a thin border of surrounding healthy breast tissue.
• To alleviate post-surgery discomfort, the surgeon will inject medication and place small marker clips in the area where the tumor was. These markers guide the radiation oncologist in directing radiation during subsequent therapy.
• Suturing the skin back together will be done by the surgeon, typically using dissolvable sutures, eliminating the need for a return visit for removal.

Lymph node removal:

During the lumpectomy, a few lymph nodes from the armpit closest to the tumor will likely be removed for testing, known as a Sentinel Node Biopsy (SNB). If cancer cells are found in the lymph nodes, it indicates potential spread beyond the tumor, requiring further treatments and tests.

Reconstructive surgery:

A reconstructive surgeon, part of your doctor, may shape and repair your breast immediately after the lumpectomy. Some individuals choose to wait until the breast tissue has healed and the shape has settled before opting for reconstructive surgery. Discuss your reconstructive surgery options with your doctor to understand its impact on care and recovery time.

Duration of lumpectomy surgery:

Lumpectomy and SNB surgery are typically outpatient procedures, allowing you to go home on the same day. Locating and removing the tumor usually takes between one to two hours, potentially longer if reconstructive surgery accompanies the lumpectomy. Release occurs on the same day, contingent on the stabilization of vital signs (pulse, blood pressure, and breathing rate).

After the procedure

Following a lumpectomy, the pathologist conducts tests on tumor and lymph node cells to determine the presence of cancer. Ideal outcomes involve negative findings in lymph nodes and a negative margin around the tumor, indicating the absence of cancer cells in surrounding healthy tissue.

However, if cancer is detected in lymph nodes or if the tumor margin is positive, further interventions such as additional surgery or specific treatments may be necessary. For instance, if cancer cells exhibit hormone receptors, hormone therapy might be recommended to counteract their growth.

Radiation therapy typically follows, lasting three to six weeks post-lumpectomy, though the duration may vary depending on individual diagnoses. Some cases may not require radiation, such as those with low-risk cancers like ductal carcinoma in situ. Treatment plans are tailored to each patient’s unique circumstances, guided by their healthcare provider’s recommendations.

Outcome

Typically, individuals experience full recovery approximately two weeks post-surgery. Immediately after the procedure, you might feel exceptionally fatigued and may encounter pain, swelling, and bruising. Your doctor might provide an ice pack to be placed in your bra to alleviate swelling. Generally, symptoms tend to improve gradually each day.

However, healing timelines can vary among individuals. It is advisable to consult your doctor for personalized recommendations on managing pain or discomfort during the recovery process.