Lumpectomy

ALSO KNOWN AS: Breast-conserving surgery, partial mastectomy

DEFINITION: A lumpectomy is a breast-conserving surgery and is the most common form of breast surgery performed for cancer. It is usually done as an inpatient procedure or as “day surgery” under general or local anesthesia when a lump or mass is found in only one section of the breast by physical examination, mammogram, ultrasound, or magnetic resonance imaging (MRI) of the breast. During a lumpectomy, the lump and some surrounding normal-appearing breast tissue are removed, and the margins between the lumpectomy and the rest of the breast are examined for any residual tumor.

Cancers diagnosed or treated: Breast cancer

Why performed: A lumpectomy is performed to remove cancer as a breast-conserving method; it is also sometimes called partial mastectomy, as opposed to complete removal of the breast, known as mastectomy. Patients may not be candidates for lumpectomy and radiation if they have more than one cancer in the same breast, have a connective tissue disease such as lupus or vasculitis, are pregnant, or have already had radiation to the same breast.

Sentinel node biopsy may also be performed on the same day of the operation to examine the lymph nodes in the armpit or axilla of the breast affected for the presence of cancer that may have spread from the primary lump or site in the breast to the lymph nodes.

Patient preparation: Lumpectomy is usually preceded by a breast biopsy performed by a radiologist or breast surgeon that confirms the presence of breast cancer and, in most cases, tells the surgeon the type of breast cancer present. This latter information allows the surgeon to decide on the need for the surgery and the type of operation necessary.

Patient instructions are NPO (from the Latin nulla per os, meaning “nothing by mouth”) after midnight on the day before the surgery. If sentinel node biopsy is performed in conjunction with lumpectomy, then the patient will need to be injected with radionuclide the day before the breast surgery. The injection is usually done around the nipple or areola by a nuclear medicine physician or radiologist. In the operating room the next day, the surgeon then uses a probe that is sensitive to small doses of gamma radiation emitted by the radiotracer to identify and remove the main draining node or nodes in the axilla, thereby eliminating the need to sample all the nodes in the axilla and thus reducing the risk of lymphedema, a swelling of the affected arm that can occur after full axillary node dissection.

Steps of the procedure: If the lump cannot be felt, then a procedure to mark the location of the mass will be performed, usually in the radiology suite on the morning of the surgery. A thin wire or needle is inserted using mammography or ultrasound to guide the radiologist, depending on whether the lesion was visible on a prior mammogram or ultrasound. This is called a breast needle (or wire) localization. The surgery itself lasts about an hour. After general anesthesia is given, the surgeon will make a curved incision in the breast, usually in the form of a smile or frown, which follows the contour of the breast to minimize scarring. After the lump and the surrounding breast tissue are removed with a scalpel, a drain may be left in place to collect excess fluid or blood, and the surgeon will then close the wound with stitches and apply a sterile dressing over the wound.

After the procedure: The patient will awake in the recovery room and may be required to stay overnight, depending on many factors, including the procedure, the patient's general health, and how easily the patient recovers from anesthesia. After two to three days, most of the tendersness should have subsided, but many patients experience swelling and firmness at the incision site for three to six months.

Risks: The risks of general anesthesia are the same regardless of the procedure. Patients who have questions about anesthesia or any part of the operation should discuss these issues with their referring physician or healthcare provider. There may be some loss of sensation in the affected breast, and the breasts may not match in size and shape after the surgery, which may be acceptable to the patient. Nerve damage is possible, particularly when the procedure occurs in the armpit.

Results: Once the pathology results are back, the doctor will review the pathology report and discuss the next steps, including the need for additional therapy.

Lumpectomy is usually, but not always, followed by radiation therapy to eliminate any possibility of microcancers (cancer that are too small to identify by physical examination or radiologic means). If the margins are not clean of cancer, then a second operation, called a reexcision, may be necessary.

Bibliography

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