LUMPECTOMY OR BREAST CONSERVING SURGERY
What is Lumpectomy
If the tumor is small and confined to a single location in the breast, you may have the option of having breast-conserving surgery, also called a lumpectomy. The goal of this relatively simple procedure is to remove the whole tumor, while conserving as much breast tissue as possible. A margin of normal breast tissue is also removed to make sure no malignant cells are left behind.
LumpectomyThe technical term for this type of surgery is partial mastectomy. Most people commonly refer to it as a lumpectomy—a “lump-removal”, so to speak. Depending on how much breast tissue is removed, the procedure may be called wide excision, segmental mastectomy, or quadrantectomy. The specific technique may vary from surgeon to surgeon and from case to case.
The cosmetic result of breast conserving surgery will vary with the location and size of the tumor, and the size of the breast. Removing a large tumor from a large breast may result in a normal-looking breast, but removing even a small tumor from a small breast may lead to noticeable change in breast size and shape that may be cosmetically unacceptable.
Women with excessively large breasts may choose to combine the removal of the tumor, with breast reduction on both sides, thus achieving both tumor control and symmetry.
Be sure to ask your surgeon how much of your breast will be removed, whether you need additional surgery on the other breast to achieve a symmetrical look, and what cosmetic side effects you might expect from radiation therapy.
If your tumor is an inch or larger, your surgeon may recommend pre-treating your tumor with chemotherapy in order to shrink it before surgery. This is called neoadjuvant chemotherapy.
Julie Reiland, MD – What is a lumpectomy?
Removing only part of the breast is refered to as breast conserving surgery. Breast conserving surgery almost always requires additional treatment of the breast area with high energy X-rays (radiation therapy) to kill any surviving cancer cells that might be left behind. This combination is called breast conserving treatment, or BCT.
A lumpectomy may be done in a hospital operating room, or in an outpatient surgery center. You may be able to go home the same day. You will want to have a friend or relative accompany you to the hospital, to provide moral support, to meet you after surgery, and to drive you home.
You’ll probably be instructed not to eat or drink after midnight on the night before surgery.
If your tumor was found on a mammogram, but is difficult or impossible to feel by touch, your surgeon may request that a needle localization procedure be done before you go to surgery. For this procedure, a radiologist will use a special mammography unit to pinpoint the location of the tumor, then mark it by inserting a thin wire into the breast. The surgeon will follow this wire to find the tumor more easily during surgery.
X-ray of needle localization…..
Before the surgery you’ll meet with the anesthesiologist to decide whether you’ll have general or local anesthesia. The choice depends on your health and on your personal preferences.
You’ll also be asked to sign an informed consent form as an indication that you understand the procedure and the possible complications, such as infection and bleeding. Make sure to read the form carefully and ask for explanations of any parts that you are not comfortable with.
If you are having a sentinel lymph node procedure (described later in this chapter) at the time of the lumpectomy, the surgeon will inject a small amount of radioactive substance into the breast area to pinpoint the sentinel node later, during surgery.
Just before you go into the operating room a nurse will start an intravenous line and give you something to help you relax.
The Surgical Procedure
A lumpectomy takes less than an hour. The skin incision will be as small and inconspicuous as possible. The surgeon will remove the tumor with a small amount of surrounding healthy breast tissue. This margin, about one-half to three-quarters of an inch in thickness, helps decrease the chance that any tumor cells are left behind.
The surgical specimen will be X-rayed to verify that all the cancer that was seen on the mammogram has been removed. Then the specimen will be sent to a pathologist who will examine it under a microscope and determine whether the margins are clear of tumor cells. If tumor cells are found along the edges, it means that some cancerous cells may have been left behind. Another lumpectomy may be done to get clear margins. In some cases, a mastectomy may be required.
Before closing the skin the surgeon may place a plastic tube called a drain to collect any fluid that may accumulate in the surgical area. This drain will be removed within a few days.
As any surgical procedure, lumpectomy carries some risks, such as infection or poor healing. Depending on where the incision is made, there may also be a scar, and permanent or temporary numbness in the lumpectomy area.
Oncoplastic procedures are a new addition to the surgeon’s options to ensure that you will benefit from effective cancer control and a enjoy a pleasing cosmetic result.
Oncoplastic surgery requires meticulous planning and skillful execution. Be sure to seek out a surgeon specially trained in oncoplastic procedures. You can learn more about this topic in the Oncoplastic Surgery section.
Recovery After Lumpectom
After the lumpectomy, you’ll be taken to the recovery room for a short while. If you didn’t have an axillary lymph node dissection at the same time as the lumpectomy, you’ll be discharged to go home. If not, you may stay in the hospital overnight. In general, you will be able to resume normal activities soon after surgery.
Follow the aftercare instructions you receive regarding how long to keep the incision dry, and when to return for a follow-up visit to your surgeon.
Have your pain medication prescription filled before you go home. Take the pills as necessary, instead of “powering through” the pain. Effective pain management improves your quality of life and helps promote healing.
If you’re going home with a drain inserted, you’ll need to empty the fluid from the detachable drain bulb a few times a day. Make sure you understand the instructions on caring for the drain before you leave the hospital.
Take sponge baths instead of showers until your drains and any staples or sutures have been removed.
Be diligent about doing whatever exercise routine you are assigned after surgery to prevent arm and shoulder stiffness.
Watch for signs of infection in your incision and call the surgeon’s office if any of them appear.
Wear a supportive bra day and night for a while to minimize any movement that could cause pain. Women with larger breasts, may find it more comfortable to sleep on the side that has not been operated on, with the healing breast supported by a pillow.
As the nerves damaged during surgery regrow, you may feel itching, and you may be very sensitive to touch. This sensation may last for months or years.
At some point n important part of breast conserving treatment is radiation therapy. Radiation therapy uses high energy X-rays applied to the breast area to kill any remaining cancer cells.
Is Lumpectomy Right for Me?
Should you have a lumpectomy with radiation, or a mastectomy? Numerous research studies, involving thousands of women and many years of follow-up, show that there is no difference in survival between the two approaches. Despite these very conclusive studies, some physicians may still favor mastectomy over breast conserving surgery. This may be due to personal bias, or to reliance on information that is now obsolete. But it may also be for very valid medical reasons. If your doctor does not offer you a lumpectomy as an option, make sure you understand why.
Besides being equally effective, breast conserving surgery offers several advantages over a mastectomy. You keep your breast, (although you may notice a change in shape), and you avoid the emotional trauma of losing the breast. A good cosmetic result can be expected, and sensation in the nipple and skin area can usually be preserved.
However, not all women can have breast conserving surgery. If the tumor is large, or the breast is small, the cosmetic results may not be acceptable after the tumor is removed. Some women are unable or unwilling to undergo the course of radiation therapy required after a lumpectomy. And a few prefer the peace of mind they expect after a mastectomy.
To ensure that you are receiving the best treatment possible for your particular case, you must meet certain criteria that will make you a good candidate for breast conserving surgery.
A lumpectomy would not be recommended if:
• There is more than one tumor in the breast.
• The tumor is so big or the breast so small that the cosmetic result would not be satisfactory after removal of the tumor.
• The tumor was found to extend beyond the margins of the tissue removed during initial surgery.
• The tumor involves the skin.
• You are not willing to have radiation therapy, or there is no convenient radiation therapy facility near you.
• You already had one course of radiation to that breast.
• You have connective tissue disease such as lupus or vasculitis.
• You want to have a mastectomy as a personal preference.