Lumpectomy – The Procedure
Lumpectomy (also called breast-conserving surgery, partial mastectomy or wide excision) is often done under general anesthesia. This means you’re asleep during the surgery. In some cases, local anesthesia with sedation, or 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.
Localization procedure at the time of surgery
Sometimes, breast cancers found by mammography (or other imaging) cannot be felt (nonpalpable).
If the tumor is nonpalpable, a localization procedure, using a very thin wire, radioactive seed (radio-seed) or other marker, will be done just before surgery. Local anesthesia is used for the localization procedure.
A radiologist will use a mammogram, breast ultrasound or breast MRI as a guide and insert the very thin wire, radioactive seed or other marker into the breast in the area of the cancer.
The surgeon uses the marker as a guide to find and remove 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. This helps the surgeon be sure all the cancer has been removed by showing whether the wire or seed are in the removed tissue.
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 clip should be placed in the breast to mark the location of the tumor. This clip is radio-opaque, so it can be seen on an X-ray. You can’t feel the clip.
Later, during a lumpectomy, the surgeon uses the clip, along with the wire, radioactive seed or other marker, 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 1-2 weeks to do a complete check of the tissue.
Clean margins (also called uninvolved 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 lymph nodes in the underarm area (axillary lymph 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 affects cancer stage, treatment and prognosis (chances for survival).
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 usually go home the same day. In rare cases, people need to 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 .
Learn about the management of surgery-related pain.
Learn more about lymphedema.
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 may 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 may help reduce the appearance of the scar.
Radiation therapy (usually given after lumpectomy) can also affect the look of the breast. It may:
- Make the breast smaller
- Change the texture of the breast
- Make the breast feel firmer
When mastectomy may be a better option
Sometimes, things 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
While not common, a woman may wish to 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 you with child and elder care costs.
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