Lumpectomy is a surgery to remove cancer from the breast. Unlike mastectomy, lumpectomy removes only the tumor and a small rim of normal tissue around it. It leaves most of the breast skin and tissue in place.
With lumpectomy, 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.
Lumpectomy is also called breast-conserving surgery, partial mastectomy and wide excision.
Radiation therapy after lumpectomy
Radiation therapy is usually given after lumpectomy to get rid of 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 :
- Breast cancer recurrence (a return of breast cancer)
- Breast cancer death
If lumpectomy and mastectomy are both options for surgery, survival with lumpectomy plus radiation therapy is the same as with mastectomy [2-3].
When is lumpectomy plus radiation therapy an option?
Lumpectomy plus radiation therapy is an option for most women who have early breast cancer or ductal carcinoma in situ (a non-invasive breast cancer).
Lumpectomy may also be an option for some women with locally advanced breast cancer after treatment with neoadjuvant therapy (drug therapy given before surgery).
In some cases, neoadjuvant therapy can shrink a tumor enough so lumpectomy plus radiation therapy becomes an option, instead of mastectomy.
When may mastectomy be the best surgical option?
A mastectomy may be the best surgical option when:
- There are 2 or more tumors in different areas of the breast (multi-centric tumors).
- The tumor is large (relative to breast size) and neoadjuvant therapy will not be given.
- The tumor has spread throughout the breast (diffuse tumor).
- The mammogram showed large areas of suspicious calcifications in the breast.
- The tumor is located just below the nipple and the cosmetic look after lumpectomy will not be good. (In some cases, lumpectomy may remove the nipple, areola and tumor but leave the rest of the breast intact.)
- The surgeon cannot get negative margins (remove all the tumor) after multiple attempts by lumpectomy.
- Radiation therapy can’t be given.
Learn about deciding between lumpectomy and mastectomy.
Who cannot have radiation therapy?
Not everyone can have radiation therapy. Being pregnant, having certain health conditions or having some 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, a woman 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 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 inherited gene mutations. In some women at higher risk of breast cancer recurrence, radiation therapy may still be used.
- Past radiation therapy to the same breast or to the same side of the chest. In general, radiation therapy to the breast can only be given once. In rare cases, radiation therapy to the same breast or overlapping parts of the body can be considered after talking with your radiation oncologist.
Although the exact treatment for breast cancer varies from person to person, guidelines help ensure high-quality care. These guidelines are based on the latest research and agreement among experts.
In addition, the National Cancer Institute (NCI) has treatment overviews.
Talk with your health care team about which treatment guidelines they use.
What to expect after lumpectomy
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 and feel of the breast. Because some tissue is removed, the breast may be smaller. There will also 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 make the breast feel firmer.
The look and feel of your breast will continue to change during the first 1-2 years after surgery and radiation therapy.
When mastectomy may be a better option
Sometimes, things like the location and size of the tumor 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.
These 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 with child care and elder care costs.
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