Lumpectomy and partial mastectomy are breast-conserving
operations in which the surgeon removes the tumor together with
some normal breast tissue surrounding it. Breast-conserving
procedures can often be done with local anesthesia and sedation or
under general anesthesia (being put to sleep) on an outpatient
basis.
Women who have this surgery usually:
- Have a single breast cancer less than 5 cm in diameter
- Have enough tissue so that removing surrounding tissue would
not leave a misshapen breast
- Are medically able to undergo surgery and follow-up radiation
therapy
Lumpectomy followed by radiation therapy is often considered the
standard therapy for women who meet these criteria. Large studies
have shown similar survival rates for both breast conservation with
radiation and removal of the whole breast, but a lumpectomy gives a
better cosmetic result.
Women who aren't candidates for lumpectomy plus radiation
include those who:
- Have had radiation to the same breast for an earlier breast
cancer
- Are pregnant and should avoid radiation
- Have multiple tumors in the breast
The surgical procedure
A lumpectomy is done under
local or general anesthesia and usually takes one to two hours.
Small metallic clips may be placed inside the breast to mark the
area for the radiotherapist to treat. Lymph nodes are often
examined at the same time as the breast tissue is removed, either
by extending the incision to the armpit or by a separate small
incision under the arm. Often, a blue dye or a small amount of
radioactive material will be injected around the nipple area. These
markers are taken up by the lymph nodes and help to identify which
lymph nodes to remove (sentinel lymph node biopsy). The tissue that
is removed from the breast is sent to the pathology laboratory
where tests are done to identify the type of tumor, whether lymph
nodes are involved by tumor, and to assess the tumor for hormone
sensitivity (estrogen and progesterone receptors). In addition,
other specialized tests that determine prognosis and treatment,
such as Her-2 neu, and oncotyping may be performed. It may take
several days to identify the type of tumor and receive the results
of the specialized tests.
Also before surgery, your doctor should provide:
- Specific instructions to follow in the days before surgery
- An overview of the surgical procedure
- Information about recovery and follow-up care
After surgery, watch for complications such as infection or
lymphedema and swelling in your arm or hand. Call your doctor
immediately if you see signs of swelling, a buildup of fluid,
redness, or other symptoms of infection.