The Who, What, Where, When and Sometimes, Why.

Lumpectomy – The Procedure

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Lumpectomy (also called breast conserving surgery, partial mastectomy or wide excision) is often done under general anesthesia. So, you are asleep during the surgery. In some cases, regional anesthesia may be used.

The surgeon makes an incision (cut) in the breast and removes the tumor, along with a small rim of normal tissue around it.

The surgeon closes the skin with stitches, trying to keep the breast looking as much as possible like it did before surgery.

The surgeon may also remove some lymph nodes in the underarm area.

The tissue removed during surgery is sent to a pathologist for testing.

Learn about test results and other information found in your pathology report.

Finding the tumor in the breast

In some cases, the surgeon uses special methods to help find the tumor in the breast.

Wire-localization or radioactive seed-localization at the time of surgery

Sometimes breast cancers found by mammography (or other imaging) cannot be felt (nonpalpable).

If the tumor is nonpalpable, a wire-localization or radioactive seed localization procedure will be done just before surgery. Local anesthesia is used with this procedure.

A radiologist will use a mammogram, breast ultrasound or breast MRI as a guide and insert a very thin wire or radioactive seed (radio-seed) into the breast in the area of the cancer. The surgeon uses the wire or seed as a guide to find and remove the tumor during surgery. The wire or seed will be removed during surgery.

Radio-opaque clip during a needle biopsy

A core needle biopsy is usually used to diagnose breast cancer. It removes a small amount of tumor tissue.

During a core needle biopsy, a radio-opaque clip is often placed in the breast to mark the location of the tumor. (You can’t feel the clip.)

Later, during a lumpectomy, the surgeon uses the clip, along with the wire or radioactive seed, as guide to find and remove the tumor. The clip is usually removed during the surgery.

Assessing margins (Was the entire tumor removed?)

A pathologist checks the tissue removed during breast surgery. By looking at the tissue under a microscope, the pathologist determines whether the entire tumor was removed.

The pathologist looks at the rim of tissue around the tumor (called a margin) to check whether it contains cancer cells. It takes about a week to do a complete check of the tissue.

Clean (also called uninvolved or negative) margins contain only normal tissue (no cancer cells).

In some cases, more surgery is needed to get clean margins.

Learn more about assessing tumor margins.

Assessing lymph nodes (Has cancer spread to the lymph nodes?)

If breast cancer spreads, the lymph nodes in the underarm area (axillary nodes) are the first place it’s likely to go.

During lumpectomy for invasive breast cancer, some axillary lymph nodes are removed to check for cancer cells. Often, there’s a separate incision in the underarm area (below where your underarm hair grows) to remove these nodes.

The presence or absence of cancer in the axillary nodes is an important factor affecting cancer stage, prognosis and treatment.

Learn more about assessing axillary lymph nodes.

Length of hospital stay

The length of the hospital stay after lumpectomy depends largely on whether axillary lymph nodes are removed.

Usually, you can go home the same day as the surgery.

Discuss the expected length of your stay with your surgeon and insurance company.

Sentinel node biopsy

If you have a sentinel node biopsy or you don’t have axillary nodes removed, you’ll likely go home the same day as your surgery.

Axillary node dissection

If you have an axillary dissection, you may go home the same day or you may stay overnight in the hospital.

A tube (surgical drain) may be placed in the underarm area to collect fluid. This drain stays in for a week to 10 days after surgery.

Learn more about sentinel node biopsy and axillary dissection.  

What to expect after lumpectomy

After lumpectomy, you’ll likely:

  • Have some soreness in your chest, underarm and shoulder
  • Feel a firm ridge below the scar while it heals (called a healing ridge).
  • Have numbness along the surgical incision (scar)

If axillary lymph nodes are removed during surgery, you may also have some numbness and a burning feeling under and behind your arm. There’s also some risk of lymphedema.

Lymphedema is a condition where fluid collects in the arm (or other area such as the hand, fingers, chest or back), causing it to swell. Today, lymphedema is not common. If it does occur, it usually develops within 3 years of breast surgery [4].

Learn more about the management of surgery-related pain.

Cosmetic issues

Women may choose lumpectomy over mastectomy to keep their breast and have it look (as much as possible) like it did before surgery.

However, lumpectomy will change the look of the breast. Because some tissue is removed, the breast may be smaller and firmer. There will be a scar and some numbness. Ask your health care provider about products that might help reduce the appearance of the scar.

Radiation therapy (usually given after lumpectomy) can also affect the look of the breast. It can further shrink the breast and change its texture or feel.

When mastectomy may be a better option

Sometimes, factors like the location and size of the tumor can make it unlikely a woman will be happy with the look of her breast after lumpectomy. In these cases, mastectomy (with or without breast reconstruction) may be the better option.

Breast reconstruction after lumpectomy

In rare cases, a woman may have breast reconstruction (either at the time of the lumpectomy or later) to maintain a more natural appearance of the breast, or to match the size and shape of the other breast.

Reconstructive surgeries are complex, so it’s best to meet with a plastic surgeon to discuss your options.

Transportation, lodging, child care and elder care assistance

You may not live near the hospital where you’ll have your surgery.

Sometimes, there are programs that help with local or long-distance transportation and lodging. Some also offer transportation and lodging for a friend or family member going with you.

There are also programs to help you with child care and elder care costs.

Learn more about transportation, lodging, child care and elder care assistance programs.  

Susan G. Komen®’s Breast Care Helpline:
1-877 GO KOMEN (1-877-465-6636)

Calls to our Breast Care Helpline are answered by a trained and caring staff member Monday through Friday from 9:00 a.m. to 10:00 p.m. ET. Our helpline provides free, professional support services to anyone who has questions or concerns about breast cancer, including people diagnosed with breast cancer and their families.

You can also email the helpline at helpline@komen.org.

 

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