Lumpectomy is a breast cancer surgery that helps remove just the cancer tumor and some of the nearby tissue. Unlike a mastectomy where the entire breast is removed, only a portion of the breast is removed in a lumpectomy, which is why lumpectomy is also referred to as “breast preservation” or “breast-conserving” surgery or partial or segmental mastectomy. Despite being least invasive, a lumpectomy is still quite effective and additional surgery is often not required. The actual portion removed would vary across patients, primarily depending on the tumor size. In case a quarter of the breast tissue has to be removed, the surgery would be called quadrantectomy. Other names for lumpectomy are wide excision biopsy, wedge resection, segmental excision, and tylectomy.
The excised tissue is usually sent to a medical lab for examination. If the excised tissue is cancerous around its rims, it indicates the patient has positive margins. Further treatment or surgery could be needed to remove any more cancer tissues remaining. In case there are no cancer cells in the tissue’s surrounding rim, it indicates the patient has clear margins surrounding the tumor. Additional surgeries may not be needed in such cases.
Lymph Node Dissection
Generally, lymph nodes such as axillary lymph nodes and sentinel lymph nodes could also be removed during a lumpectomy to ascertain if the cancer has made inroads beyond the breast. During axillary node dissection, several lymph nodes are removed from the patient’s armpit near the tumor. Sentinel node dissection, on the other hand, entails removal of a maximum of two nodes (sentinel nodes) within which the tumor drains.
Axillary node removal is the most extensive procedure of the two, which is why it’s performed only if a biopsy of the lymph nodes done prior to the surgery exhibits cancer signs. The hospital stay post axillary node removal is at least a couple of days, especially if there is bleeding or pain. Sentinel lymph nodes are usually extracted when there aren’t any concerns about amplified lymph nodes. If the sentinel nodes do not exhibit cancer, no additional surgery would be needed. In case cancer is present, more lymph nodes would probably get removed from the armpit.
Ideal Lumpectomy Candidates
Women who are diagnosed early or who are in initial stages of breast cancer respond best to a lumpectomy. Ladies with certain precancerous or noncancerous breast abnormalities could also undergo lumpectomy. Generally, lumpectomy could constitute treatment for invasive ductal carcinoma or ductal carcinoma in situ (DCIS). But there are cases where a lumpectomy is not advised, such as:
- A lumpectomy would dramatically disfigure the breast if there are several cancers in multiple areas of a breast or the tumors have a diameter of 5cm or more. A mastectomy is recommended in such cases.
- Certain physical or medical scenarios could also discard lumpectomy as a viable treatment choice. For instance, the surgeon would not be able to remove tumor with necessary quantity of nearby normal tissue. This absence of clear margins is referred to as “persistently positive margins”.
- A previous lumpectomy coupled with radiation as repeated radiation in the same breast can be harmful.
- Lumpectomy would be ineffective if the cancer is extensive since a lumpectomy focuses on a specific area.
- A troublesome tumor that is developing rapidly or is attached to chest skin or wall.
- Pregnant women are not advised lumpectomy since radiation therapies could be harmful to the unborn kid. Similar is the case with women who have medical conditions that could get worse with radiation therapy.
Lumpectomy is an outpatient procedure, meaning overnight hospital stay is usually not required. As aforementioned, lumpectomy is less invasive when compared to mastectomy and is also as effective as mastectomy when it comes to treating early-stage breast cancer. Invariably, the patient can keep the majority of her breast intact with a lumpectomy. Since only a portion of the breast is removed, breast reconstruction surgery is also not always mandatory. The requirement for reconstruction, however, would depend on the size of the breast tissue removed.
Lumpectomy is a surgery and there are bound to be risks attached to it. It’s common for the patient to experience some level of numbness or zero sensation in the operated breast. The level or area of numbness would depend on the excised lump’s size. Infection, damage to neighboring tissues, and bleeding are other risks. Nerve damage could be an issue in some women, leading to permanent sensation loss in the breast and/or inability to control arm movement.
On the cosmetic front, the operated breast may lose its original size and shape and may not match the physical dimensions of the other breast. Any therapy thereafter such as radiation or chemotherapy would only make matters worse. Since a portion of the breast is removed, the operated breast would be smaller in size. In case both the breasts were operated upon, this size mismatch should be less of an issue. Generally, doctors would try their best to keep the breast as symmetrical as possible. However, in this quest to preserve as much breast possible, a doctor could inadvertently leave behind some traces of the cancer, which is why a lumpectomy is invariably followed by additional surgeries.
However, things cannot get any worse than a mastectomy where the entire breast is removed. This explains why women who are particular about the appearance of their breasts after surgery opt for a lumpectomy, if the option is available to them. By the way, the size reduction won’t be apparent straightaway since it would take some time for the surgery-related swelling to subside and reveal the breast’s actual size.
Right after surgery, the patient is shifted to a recovery room where her vital health statistics such as body temperature, heart rate and blood pressure are measured and constantly monitored. If lymph nodes have been removed too with the breast tissue, the patient would have to stay in the hospital overnight. As far as at-home care is concerned, the usual drill applies here too, including instructions on pain medication, infection prevention, how to care for the bandage and surgical drain, rest required, arm exercises, rest, etc.
Most patients are administered radiation therapy for a month or two after a lumpectomy to get rid of the cancer cells that could be housed in the leftover tissue. When a lumpectomy is combined with radiation, the overall therapy is referred to as breast-conserving therapy. In case chemotherapy is to be administered too, then radiation therapy would have to wait for its turn after chemo. Unfortunately, the chances of recurrence cannot be completely ruled out even after breast-conserving therapy.