Overview

Lumpectomy is a surgical procedure to remove a tumor in the male or female breast, which could be benign or malignant – more commonly benign than malignant.

Along with the removal of the breast tumor, lumpectomy also involves removing some amount of surrounding normal breast tissue to ensure that no cancer cells are left behind and cause recurrence. Lumpectomy is therefore breast lump removal and it forms part of breast cancer treatment.

Though breast lumpectomy is an invasive procedure, compared to mastectomy it is relatively less invasive, as the breast is preserved. It is, therefore, referred to as breast conservation surgery or breast preservation surgery.

Technically speaking, lumpectomy is a partial mastectomy, as it involves the removal of part of breast tissue. However, the amount of breast tissue that is removed varies from person to person.

After the surgery, the surgeon sends the breast tumor to the pathology department for histopathology examination to rule out cancer. The pathology report will be ready after 3 to 7 very anxious days.

Lumpectomy also becomes the treatment of choice in the early stages of breast cancer, where the cancer is restricted to the tumor only and has not invaded. However, patients who undergo lumpectomies are subjected to radiation treatment later to prevent a recurrence.

Indications for Lumpectomy and follow up Radiation

Your surgeon will recommend a lumpectomy if the breast biopsy has shown a contained cancerous growth that is small and in the early stage. He will also recommend it on a noncancerous tumor.

The purpose of lumpectomy is to remove a cancerous lump or any other abnormal tissue from the breast and also maintain your breast appearance.

Studies indicate that for early-stage breast cancer, lumpectomy followed by radiation therapy is equally effective in preventing a recurrence as mastectomy is.

The patient has to be medically fit to undergo surgery. Other indications include:

  • Lumpectomy is the surgery of choice in the early stage of breast cancer where there is a single breast tumor that measures less than 5 cms across.
  • It is indicated for the removal of benign tumors such as fibroadenoma or phyllodes.
  • It is also recommended for ductal carcinoma in situ or an early-stage small invasive breast cancer that will allow for breast conservation.
  • Lumpectomy is also performed when an ambiguous pathology report is obtained on a core or fine-needle aspiration biopsy of a suspicious breast lump seen in an imaging procedure.
  • When a biopsy under radiologic guidance is difficult

Contraindications for Lumpectomy and follow up Radiation

  • Presence of more than one tumor in the breast
  • Previous history of breast cancer and radiation in the same breast
  • Pregnancy
  • Spread of cancer throughout the breast, leaving insufficient normal breast tissue
  • A large tumor in a small breast in which a lumpectomy may cause cosmetic complications
  • Connective tissue inflammatory diseases like lupus or vasculitis make the patient extremely sensitive to radiation side effects.
  • When the lump is large and a lumpectomy would involve removing more than 30% of the breast tissue, this surgery is not recommended. A tumor of 3-4 cm is considered ideal for this surgery in medium to large-sized breasts.
  • Patients who undergo lumpectomy have to undergo postoperative radiotherapy to the chest wall to prevent a recurrence. Lumpectomy is, therefore, contraindicated in patients with severe psoriasis and sarcoidosis.

Risks

Lumpectomy is a surgical procedure that carries a risk of side effects. These include:

General risks 

  • Bleeding
    Infection
    Reaction to drugs post-surgery

Specific risks of lumpectomy:

  • Disfiguring of the breast
  • The difference in the size of both breasts
  • Scarring of the healed incision
  • Numbness over the operated breast
  • Phlebitis is inflammation of the vein in the arm of the same side
  • Lymphedema is swelling under the armpit of the same side. This happens in up to 10% of the lumpectomy cases where the axillary lymph nodes are also removed due to the lymphatic spread of cancer.

Lumpectomy Procedure

Anesthesia. Usually General.

Duration of lumpectomy: One to two hours.

Hospital stay: Most patients are discharged on the same day. Some may require to stay for a day or two depending on the amount of excised breast tissue.

Lumpectomy is performed under general anesthesia. The surgeon first locates the tumor. He does this with the help of a mammogram or a breast ultrasound.

By an incision over the breast, the oncosurgeon separates the tumor from the adjacent tissue and removes it. He also removes some amount of normal breast tissue surrounding the tumor to ensure that no cancer cells are left behind.

The surgeon also confirms whether cancer has spread to the axillary lymph nodes or not. He does this by doing the sentinel node biopsy.

Sentinel Node Biopsy

The surgeon identifies the lymph node, which first drains that part of the breast where the tumor is situated. He does this by injecting a dye or radioactive substance before surgery near the tumor and identifying the first one or two lymph nodes where the visible dye drains. These are called the sentinel lymph nodes. For the breast, they are usually located in the axilla (armpit).

He removes the lymph node by a procedure called the sentinel node biopsy. He then sends the sample to pathology to look for cancer cells. If the report comes negative, then he concludes that the other lymph nodes are intact.

If the report is positive, the surgeon removes other lymph nodes of the breast. Such cases require chemotherapy and radiation after surgery to improve survival. This also reduces the chances of lymphedema (chronic swelling of the armpits), which often occurs after the removal of the lymph nodes.

After surgery, the surgeon sutures the wound keeping in mind cosmetic compulsions.

Recovery after Lumpectomy

  • Most women who undergo lumpectomy are discharged from the hospital the same day. After surgery, you are shifted to a recovery room for a short time where you are monitored until you wake up and are stable. However, a few women who have undergone axillary lymph node dissection may have to stay in the hospital for one to two days till they stabilize.
  • You should be aware of the complications and risks of lumpectomy explained above and inform the doctor of the appearance of any symptoms.
  • The surgeon may leave a drain to draw off blood and fluid.
  • He will provide you with a prescription for pain medication and an antibiotic.
  • He will ask you to follow up with the out-patient after seven days.
  • You should avoid lifting heavy objects and jogging for 2 weeks.
  • You can resume normal activities within a week or so but only with the consent of your doctor.
  • Radiation treatment is started immediately after lumpectomy for 5 to 7 weeks to prevent a recurrence.
  • Chemotherapy and/or hormone therapy may also be required in certain cases. However, in such cases, radiation is started after chemotherapy has been concluded.
  • Reconstruction breast surgery is usually not required after lumpectomy.

Prognosis | Survival

The lumpectomy survival rate is very encouraging. Lumpectomy followed by radiation offers better survival rates than mastectomy for early-stage breast cancer. Breastcancer.org gives detailed stats

  • Two studies concluded that survival after lumpectomy and mastectomy for breast cancer tumors less than 4 cms was comparable and similar. In both surgeries, women lived a disease-free life even 20 years after surgery.
  • Recurrence can still occur with lumpectomy followed by radiation. In one study, 14% while in another study 9% of women showed recurrence. However, local recurrence confined to the breast only (which has occurred after lumpectomy) is treated with mastectomy and you can expect a disease-free survival for 20 years.

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