Lumpectomy
Breast Cancer Surgery

breast surgery Breast Cancer

Lumpectomy Picture

Lumpectomy

Contents

What Is A Lumpectomy?
When Is It Not Performed?
What Happens During The Procedure?
Re-Excision Lumpectomy
What About Radiation?
What About Chemotherapy?
Questions To Ask Your Surgeon


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Breast Cancer Guidelines

What Is A Lumpectomy?

A lumpectomy is a surgical treatment for breast cancer that is increasingly being performed, usually in combination with radiation. It may also be used to remove non-cancerous benign lumps such as fibroadenomas. A lumpectomy may also be referred to as a tumor excision, tylectomy or tumorectomy. The operation involves removing only the tumor mass (as opposed to a mastectomy procedure which removes the entire breast) and a small amount of surrounding tissue. Technically, because it does remove breast tissue, it could be called a partial-mastectomy. It is the least invasive of all breast cancer surgeries and is usually done under local anesthesia. The breast is left essentially unchanged in appearance. If slightly more of the surrounding tissue is removed then the procedure is called a wide excision, wedge resection, quadrantectomy or segmental resection. Most surgeons will also perform an axillary node dissection with lumpectomy. This involves making a small incision in the underarm and removing some axillary lymph nodes for biopsy. They will be sent to the lab for testing to check if cancer has spread to them. This is an important part of breast cancer staging and helps doctors determine the best course of treatment for the woman. If cancer is detected in the lymph nodes there is a good chance cancer has also spread to other parts of the body through the bloodstream. A sentinel lymph node biopsy (SLNB) is an alternative type of breast biopsy to this procedure.

When Is It Not Performed?

Although the breast cancer survival rate for women who undergo lumpectomy is generally as good as those who have a mastectomy, it is not always the appropriate choice. For example, it is not appropriate for women whose workups before surgery (blood tests, X-rays, bone scans, mammogram screening) indicate that cancer is likely to recur or where more than one primary cancer is discovered (advanced stages). It also offers no particular advantage to women with small breasts or those with cancer centrally located in the breast. This is because there will be very little difference in the cosmetic results to removing the entire breast. Breast reconstruction surgery will be required anyway.

Yet, because lumpectomy is really an optimal treatment in many ways, research is being carried out to the benefits of shrinking tumors before surgery with chemotherapy. This may make it possible for women who would not normally be candidates to carry out a lumpectomy with radiation therapy.

On the hand, many women, despite being obvious candidates for lumpectomy, still choose mastectomy. Some may fear the effects of radiation while others feel safer ridding their body of all possible cancer tissue. For elderly women living in remote locations, daily trips to a radiation center associated with lumpectomy may simply not be practical. Furthermore, a physician's preference also seems to be a factor. For example women in the Southern States are more likely to have a mastectomy than those in the Northeast. This may be because doctors in the South don't want to change their technique, or because they simply believe mastectomies are safer.

Two studies published by the New England Journal of Medicine (2002) showed that women with small tumors (under 4cm) treated with lumpectomy and radiation were just as likely to be disease free 20 years later than women who had mastectomies. However, 14 percent of women in one study (and 9 percent in the other) had local recurrences (confined to the breast). They were then treated with mastectomy and continued to live disease free 20 years after the breast cancer recurrence treatment.

A breast cancer diagnosis is rarely a medical emergency, so if you have been diagnosed, do take a few weeks to investigate your options. Always seek the opinion of at least 2 surgeons and read some books on breast cancer, there are many available online or in the local library.

What Happens During The Procedure?

Before Surgery

You arrive in hospital on the day of surgery and change into a hospital gown in the preoperative holding area. If the tumor is too small to see the surgeon will locate it with an ultrasound scan or mammogram before surgery and mark it out with a felt-tip pen on the skin. You are then taken to the anesthesia room where a nurse inserts an IV line into your hand or arm. You may be given a sedative to help you relax. Most women opt for a local anesthetic when undergoing lumpectomy, but some choose a general anesthetic.

During Surgery

The procedure takes about 30 to 40 minutes. The surgeon normally uses an electrocautery knife, which is an electric scalpel designed to minimize bleeding. Normally they will carry out a curved incision that follows the natural curve of the breast and the lump is removed, along with some surrounding tissue. In some cases a rubber drainage tube is inserted into the breast area or armpit to keep the space where the tumor was free of fluids (preventing lymphedema). It is attached to suction device called a drain bulb. Then the wound is stitched closed and a wound dressing applied. The patient is moved to the recovery room where vital signs such as heart rate and blood pressure are monitored. An overnight stay is not normally necessary unless the patient also had lymph nodes removed. See also, Cancer Surgery.

Post-Surgery

The nurse should explain how to take care of the wound dressing, although some surgeons insist in leaving it until your first follow up visit 1 or 2 weeks later. If you are to go home with drainage tubes in place you will need to empty the portable drain bulb several times a day. Again you will be advised how to do this. When it comes to stitches, most surgeons use sutures which dissolve naturally over time, so there is no longer the need to have them removed. However if staples are used, these will need to be removed by the surgeon on your first follow up visit. You will also be told about special arm exercises to carry out in the morning to prevent stiffness in the shoulder and arm area. If you still have a drain in place, you will need to wait until it is removed before exercising. See also Cancer Surgery Recovery.

Re-Excision Lumpectomy

After surgery part of the removed tissue (and lymph nodes if taken) is examined carefully under a microscope for signs of cancer. If cancer cells are discovered on the edge (margins) of the tissue sample, then the surgeon will have to re-operate and remove more tissue to create a safe margin (known as ‘clearing the margin’). This procedure is called re-excision lumpectomy. If too much tissue is required to achieve a safe margin then mastectomy will be required.

What About Radiation?

Nearly all lumpectomies will require radiation therapy after surgery; this is to ensure no cancer cells remain hidden in the breast area. Radiation is usually required 5 days a week for 6 weeks. Each session should only last a few minutes. The side effects of lumpectomy itself are minimal - but radiation can cause redness and swelling of the breast as well as fatigue, muscle pain and increased sensitivity to light. Frequent mammograms are necessary after a lumpectomy, the first is usually carried out within 6 months to monitor for signs of recurrence. A follow up physical examination is carried out every 3 months for the first year after radiation, every 4 months in the second year and every 6 months after that.

What About Chemotherapy?

Lumpectomy as a procedure has been opposed by conservative doctors, despite the fact it gives just as good breast cancer survival rates as mastectomy. It is increasingly being used for stage 1 and 2 breast cancer. Furthermore recent research shows that administering chemotherapy (see chemotherapy guide) to shrink the lump before surgery reduces the risks of further radical surgery later. In the future this approach (chemo, followed by surgery and radiation), pending study results, is expected to be applied to 45 percent of all lumpectomies. In some instances hormone therapy for breast cancer may be an alternative.

Questions To Ask Your Surgeon

• How many lumpectomies do you perform?
Ideally he should perform 15 or more a month.
• What risks are associated with the operation?
• What should I do to prepare for surgery?
• How much tissue exactly will you remove?
• Will I need a fluid drain?
• What will my breast look like after the operation?
• Will you remove any underarm lymph nodes for biopsy?
• What kind of anesthesia will I need?
• Will I need a blood transfusion and if so, should I donate my own blood before the operation?
• How long do I stay in hospital?
• How long will it take to recover?
• Will I lose any mobility in my arm?
• What exercises should I do after surgery?

Related Articles on Cancer

For more overviews and advice, see the following:

Cancer Guide
Preventing Breast Cancer

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