Lumpectomy – What You Need to Know

A lumpectomy is an option for most people who have early breast cancer or ductal carcinoma in situ (a non-invasive breast cancer).

A lumpectomy may also be an option for some people with locally advanced breast cancer after treatment with neoadjuvant therapy (drug therapy given before surgery). Neoadjuvant therapy is also called preoperative therapy.

In some cases, neoadjuvant therapy can shrink a tumor enough so a lumpectomy becomes an option instead of a mastectomy. Unlike a mastectomy, a lumpectomy removes only the tumor and a margin (a small rim of normal tissue around the tumor), leaving most of the breast skin and tissue in place.

Radiation therapy is usually given after a lumpectomy to kill any cancer cells that might be left in the breast.

Learn about radiation therapy after a lumpectomy.

Learn about deciding between a lumpectomy and a mastectomy.

Learn when a mastectomy may be the best surgical option.

Lumpectomy – the procedure

With a lumpectomy, most of the breast skin and tissue are left in place so that the breast looks as close as possible to how it did before surgery. Most often, the general shape of the breast and the nipple area are preserved.

In some cases, a person may get 2 lumpectomies in the same breast.

Lumpectomy surgery

A lumpectomy is often done under general anesthesia. This means you’re asleep during the surgery. In some cases, local anesthesia (numbing medication) with sedation may be used.

During surgery:

• The surgeon makes an incision (cut) in the breast and removes the tumor, along with a margin (a small rim of normal tissue around the tumor).
• 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 axillary lymph nodes (lymph nodes in the underarm area).

The tissue and any axillary lymph nodes removed during surgery are sent to a pathologist for testing.

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

Learn about what to expect before and after a lumpectomy.

Finding the tumor in the breast

Sometimes, breast cancers found by mammography or other imaging test cannot be felt during a physical exam. In these cases, the surgeon will use special methods to help locate the tumor in the breast.

Localization procedure at the time of surgery

If the tumor can’t be felt, a localization procedure to find it will be done just before surgery. Local anesthesia is used for this procedure.

During the procedure:

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

After the tumor is removed, it’s usually X-rayed. The X-rays show whether the wire, seed or other marker was in the removed tissue. This helps the surgeon be sure all the cancer visible on imaging was removed.

Radio-opaque clip during a needle biopsy

Most often, a core needle biopsy is used to diagnose breast cancer. It removes a small amount of tumor tissue.

During a core needle biopsy, a tiny clip should be placed in the breast to mark the location of the tumor. This clip is radio-opaque, meaning it can be seen on an X-ray.

Later, during surgery, the surgeon uses the clip (along with the wire, radioactive seed or other marker) as a guide to find and remove the tumor. The clip is usually removed during the surgery. If you’re worried about the clip, know that it’s safe and you can’t feel it.

Assessing margins (Was the entire tumor removed?)

A pathologist checks the tissue removed during breast surgery. It takes about 1-2 weeks to do a complete check of the tissue.

The pathologist looks at the tissue under a microscope. They determine whether the entire tumor was removed by checking to see if the margins (the small rim of tissue around the tumor) contain cancer cells.

Clean margins (also called uninvolved margins or negative margins) contain only normal tissue on their outer edges. This means there are no cancer cells at the margins.

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 axillary lymph nodes (lymph nodes in the underarm area) are the first place it’s likely to go.

Before a lumpectomy for invasive breast cancer, you may have an ultrasound of the underarm area to check for signs of cancer in the axillary lymph nodes.

• For some women 50 years and older with ultrasound findings that show no signs of cancer in the axillary lymph nodes, a sentinel node biopsy may not be needed [3].
• For other women and for men, some axillary lymph nodes may need to be removed during the lumpectomy.

If you need to have axillary lymph nodes removed, the surgeon will often make a separate incision (cut) in the underarm area (below where your underarm hair grows). The axillary lymph nodes that are removed will be sent to a pathologist who will check whether or not the nodes contain cancer cells.

The presence or absence of cancer in the axillary lymph nodes affects cancer stage, treatment and the chances for survival.

Learn more about assessing axillary lymph nodes.

Length of hospital stay

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

However, the length of the hospital stay after a lumpectomy depends on whether axillary lymph nodes are removed.

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

Sentinel lymph node biopsy

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

Axillary lymph node dissection

If you have an axillary lymph node dissection, you usually go home the same day. In some cases, people need to stay overnight in the hospital.

With an axillary lymph node dissection, a surgical drain may be placed in the underarm area. A drain is a small tube that allows extra fluid from the surgery to escape. This drain stays in for a week to 10 days after surgery.

You will learn how to take care of the drain.

Learn more about sentinel lymph node biopsy and axillary lymph node dissection.

Breast reconstruction after a lumpectomy

While not common, some women have breast reconstruction to maintain a more natural appearance of the breast, or to match the size and shape of their other breast. Breast reconstruction may be done at the time of the lumpectomy or at a later date.

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

Radiation therapy after a lumpectomy

Radiation therapy is usually given after a lumpectomy to kill any cancer cells that might be left in the breast. These cells are too small to see on mammograms or other imaging tests, or to measure with lab tests.

Radiation therapy can lower the risk of [4]:

• Breast cancer recurrence (a return of breast cancer)
• Death from breast cancer

If both surgeries are options, overall survival is the same for a lumpectomy plus radiation therapy and a mastectomy [1-2]. This means both treatments lower the risk of dying (from breast cancer or other cause) by the same amount.

After a lumpectomy, chemotherapy, hormone therapy, HER2-targeted therapy and/or other drug therapies may be given. If your treatment plan includes chemotherapy, radiation therapy is given after chemotherapy.

Who cannot have radiation therapy?

Not everyone can have radiation therapy. Being pregnant, having certain health conditions or having certain inherited gene mutations can make radiation therapy harmful.

• Pregnancy. Radiation can harm a fetus. Depending on the timing of the pregnancy and the breast cancer diagnosis, you may be able to have a lumpectomy and safely wait until after delivery to have radiation therapy.
• Scleroderma. Radiation therapy can cause harm to normal tissue during and after breast cancer treatment in people who have scleroderma. In some women at higher risk of breast cancer recurrence, radiation therapy may still be used.
• Some inherited gene mutations. Radiation therapy can cause harm to normal tissue during and after treatment in people who have certain rare, inherited gene mutations. In some women at higher risk of breast cancer recurrence, radiation therapy may still be used (if the radiation oncologist determines it can be done safely).
• Past radiation therapy to the same breast. In general, radiation therapy to the breast can only be given once. However, repeat radiation to the chest is sometimes recommended for the treatment of breast cancer recurrence. And, some data suggest repeat radiation therapy to a portion of the breast may be a reasonable option for certain women who had a lumpectomy for breast cancer in the past [5]. The radiation oncologist will determine if repeat radiation therapy can be done safely.

What to expect after a lumpectomy

Pain and numbness

After a lumpectomy, you’ll likely:

• Have some soreness in your chest, underarm and shoulder
• Feel a healing ridge (a firm ridge below the scar while it heals)
• 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. Placing a small pillow below your underarm may make you more comfortable.

Pain related to surgery may be treated with mild pain relievers or if the pain is more severe, prescription medication.

Learn about the management of surgery-related pain.

Limited range of motion in the shoulder area

If you have a sentinel lymph node biopsy to remove axillary lymph nodes during surgery, you may have short-term problems with the range of motion in your shoulder area (the ability to move the shoulder easily). These problems may last longer after an axillary lymph node dissection than after a sentinel lymph node biopsy.

If you have an axillary lymph node dissection, your health care provider may recommend special exercises to improve your range of motion. They may also refer you to a physical therapist if needed.

Risk of lymphedema

If axillary lymph nodes are removed during surgery, there’s a risk of lymphedema.

Lymphedema is a condition where fluid builds up in the arm and/or hand, causing it to swell. Today, lymphedema isn’t very common. If it does occur, it usually develops within 3 years of having axillary lymph nodes removed [6-7].

Learn more about lymphedema.

Cosmetic issues

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

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

Radiation therapy (usually given after a lumpectomy) can also affect the look of the breast. It may:

• Make the breast smaller or larger
• Change the texture of the breast
• Make the breast feel firmer
• Make the skin where the breast was treated have mild tanning or red discoloration

The look and feel of your breast will continue to change during the first 1-2 years after surgery and radiation therapy.

Emotional health after a lumpectomy

After a lumpectomy, you may feel some common emotions. Any anxiety you might have had leading up to surgery could have eased, but you may be worried about what happens next. You may also feel a sense of relief about getting through this part of your treatment. This is all normal.

Make sure you take time to recover both physically and emotionally. You may want to have family and friends available for support.

Learn more about social support.

Sexuality and intimacy

Listen to our Real Pink podcast, Regaining Intimacy After Breast Cancer.

Sex and intimacy can be difficult for many women after a breast cancer diagnosis and treatment. Problems can increase over time, so it’s good to address them early. There are ways to improve many aspects of sexuality and intimacy.

Your health care provider can treat many treatment side effects that can impact your sex life, such as vaginal symptoms and other menopausal symptoms.

Open communication between you and your partner is important. A mental health provider, such as a clinical social worker, counselor, psychologist or sex therapist, can offer treatment and support services for you and your partner.

Learn more about sexuality and intimacy after breast cancer treatment.

When a mastectomy may be the best surgical option

Sometimes, a mastectomy is the best surgical option. For some people, a lumpectomy can’t remove all of the tumor. In other cases, the location and size of the tumor make it unlikely a woman will be happy with the look of her breast after a lumpectomy.

A mastectomy may be the best surgical option when:

• There are 2 or more multi-centric tumors (tumors in different areas of the breast), and when multiple lumpectomies can’t be done with a good enough cosmetic result.
• The tumor is large (relative to breast size) and neoadjuvant therapy is unlikely to make the tumor shrink.
• The tumor is diffuse (has spread throughout the breast).
• The mammogram showed large areas of suspicious calcifications in the breast.
• A breast MRI before surgery showed extensive abnormal tissue in the breast which can’t be removed with a lumpectomy.
• The tumor is located just below the nipple and the cosmetic look after a lumpectomy will not be good. (In some cases, a lumpectomy may remove the nipple, areola and tumor but leave the rest of the breast intact.)
• The surgeon can’t get negative margins (remove all the tumor) after multiple attempts by a lumpectomy.
• Radiation therapy can’t be given.

In these cases, a mastectomy (with or without breast reconstruction) may be the better option.

Some women who have the option of a lumpectomy, choose to have a mastectomy for other reasons.

Learn about deciding between a lumpectomy and a mastectomy.

Treatment guidelines

Although the exact treatment for breast cancer varies from person to person, evidence-based guidelines help make sure high-quality care is given. These guidelines are based on the latest research and agreement among experts.

The National Comprehensive Cancer Network (NCCN) and the American Society of Clinical Oncology (ASCO) are respected organizations that regularly review and update their guidelines.

In addition, the National Cancer Institute (NCI) has treatment overviews.

Talk with your health care team about which treatment guidelines they follow.

After you get a recommended treatment plan from your health care team, study your treatment options. Together with your health care team, make thoughtful, informed decisions that are best for you. Each treatment has benefits and risks to consider along with your own values and lifestyle.

You’re not alone

If you’re facing breast cancer surgery, it’s normal to feel worried or afraid. Many people have been where you are today. They had the same fears and faced the same tough choices. They’ve gone through breast cancer treatment and are adjusting to life after it.

It may be helpful for you to talk with others who’ve finished treatment to help ease your fears. Having people in your life who can relate to some of what you’re going through may help you feel less alone.

You can do this in a support group or by connecting one-on-one with another breast cancer survivor. A social worker or patient navigator can help you find these resources.

You can also talk with your health care providers about how you’re feeling. They care about your overall well-being and want to help. They may connect you to a mental health provider on your health care team, such as a social worker, for emotional support.

Our Support section has a list of resources to help you find local and online support groups and other resources.

Learn more about social support and support groups.

Learn about ways to cope with stress.

Financial assistance

Costs related to surgery can become a financial burden. Dealing with finances and insurance can be overwhelming.

Many hospitals have financial counselors who can discuss insurance and cost coverage with you. They may be able to arrange a payment plan for hospital-related costs.

You may qualify for financial assistance from federal, state or local programs. A financial counselor or social worker at your hospital can help you learn about these programs.

Learn about insurance and financial assistance programs.

Komen Financial Assistance Program

Susan G. Komen® created the Komen Financial Assistance Program to help those struggling with the costs of breast cancer treatment by providing financial assistance to eligible individuals. To learn more about this program and other helpful resources, call the Komen Patient Care Center at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org. Se habla español. Learn about other financial assistance programs.

Transportation, lodging, childcare and eldercare assistance

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

There may be resources available if you need a ride to and from surgery or help with childcare or eldercare. Family and friends often want to help but don’t know how. These are great ways for them to get involved. It’s OK to ask for help.

There may be some programs that help with local or long-distance transportation and lodging (if you need a place to stay overnight). Some programs may offer assistance with childcare or eldercare costs.

A social worker, patient navigator or financial counselor can help connect you with these resources. You can also contact Komen’s Patient Care Center at 1-877 GO KOMEN (1-877-465-6636) or email helpline@komen.org.

Learn about transportation, lodging, childcare and eldercare assistance programs.

Learn about resources that offer social support and practical support.

Educational resources

Find:

• A list of questions you may want to ask your health care provider before and after surgery
• Our Questions to Ask Your Doctor About Breast Surgery resource

Read our fact sheets on:

• Breast cancer surgery
• Axillary lymph nodes
• Support after a breast cancer diagnosis

Watch our BC101 interactive video on lumpectomy.