Lumpectomy is performed by removing a breast tumor or cancer, and also removing a margin of healthy tissue surrounding the tumor. Additional tissue will continue to be removed in that initial surgical session until the doctor arrives at what is called a “clear” margin, or area around the tumor that shows no preliminary evidence of cancer. Following surgery, a complete microscopic evaluation is done of the outermost margin of healthy tissue. If tumor cells are found to be present at this stage of evaluation, then further surgery, or a reexcision, will likely be recommended so that additional tissue and all possible cancerous cells are removed. Depending on the extent of the re-excision necessary, a mastectomy may be recommended. Good candidates for lumpectomy are generally women who have no previous history of breast cancer in the affected breast, or fewer than two current areas of beast cancer in the same breast.
In addition, good candidates have not previously had radiation to the chest or afflicted breast area. Women who are pregnant and whose cancers will likely require localized radiation may not be good candidates for breast conserving surgery, as added radiation therapy may harm the fetus. In addition, women who are not good candidates for radiation therapy because of other medical conditions, like connective tissue disorders (CTD), are not good candidates for breast conserving surgery. In cases where tumors are located in aesthetically sensitive areas, such as directly behind the nipple and areola, a mastectomy may be recommended because a lumpectomy can be highly disfiguring. In general, women with tumors estimated to be 5 centimeters in diameter or larger, or small-breasted women whose tumors are large in relation to breast size, may not be good candidates for lumpectomy, as it is more likely the procedure will be highly disfiguring. Depending on the extent of your lumpectomy and your overall health, the procedure may be performed on an outpatient basis using local anesthetic with or without sedation, or with a general anesthesia.
An inpatient hospital stay may also be recommended, particularly if the disfigurement is significant enough to require reconstruction. Most cases of lumpectomy do not require formal breast reconstruction. Occasionally, a local rearrangement of remaining breast tissue at the time of lumpectomy can minimize a deformity caused by removing breast tissue. If formal reconstruction using the woman’s own tissue moved from another part of the body to the breast is recommended, this is usually delayed. Reconstruction will take place after pathological confirmation of negative margins (no additional malignant cells in tissue surrounding the tumor) or after the final extent of the deformity has been ascertained. Surgery performed on an outpatient basis allows you to recover at home, barring any complication or unexpected events during surgery. Inpatient surgery, with or without reconstruction, will include a one- to twonight hospital stay. However, a flap procedure for reconstruction may extend your stay to three to five days or more. You will likely experience localized swelling and tenderness in your breast. Your pain and discomfort will likely be localized to the area where surgery was performed on the breast, and can be comfortably controlled with medication. As healing progresses, you may notice your incision sites are firm and may become somewhat itchy. It is important to follow your doctor’s advice with regard to cleansing wounds, leaving surgical tape intact, and applying ointments as recommended. This will help the scars to heal.
In addition, a soft support bra (without underwires) or camisole with a shelf bra may be most comfortable in those first few days. Avoid anything that applies too much pressure to the breast. Lumpectomy does not generally require drains at the surgical site, but in some cases they may be used. Drains are hollow tubes placed in a wound cavity to prevent fluid collection. If drains are used, they will be removed within several days following surgery, depending upon the recommendation of your breast surgeon. Risks of lumpectomy include potential risks following any surgery. In addition, there is the possibility of a developing a seroma (fluid collection in the space where the tumor was removed) that does not resolve. This can generally be drained though aspiration (removal with a needle) in your doctor’s office. Although rare, the space may continue to collect fluid. If this happens, treatment includes compression to close the space. While there is a high success rate with lumpectomy and breast conserving surgery, immediate reconstruction with the use of a breast implant is generally not recommended in these cases. Mammography and follow-up to carefully monitor any recurrence of the tumor or cancer is essential to your course of treatment and, depending on the location of the original cancer or tumor, a breast implant may interfere with the ability to detect some changes in the breast tissue through mammography.
In general, women who undergo lumpectomy may be back to moderate activity within a day or two of returning home. Within two weeks, most women are fully active, although the necessary radiation treatments with breast conserving surgery may have some side effects that slow you down. Lumpectomy is a procedure that is growing in numbers, due to the success of outcomes both in your health, and in the appearance of your breast. Careful planning with your breast surgeon and cosmetic surgeon, and a review of all your options is essential to your satisfaction and your overall health prognosis. While the physical stress of lumpectomy may be much less than a mastectomy, you still need time to recuperate, both physically and emotionally. The support of your family and friends may not be enough. Ask your surgeon or physician for local support groups or sources of individual support in your area to give you the assistance you need to get back to your daily life. According to an October 2002 study published in the New England Journal of Medicine, women treated with lumpectomy and radiation were as likely to be alive and disease free 20 years after surgery as those women who had radical mastectomy. The National Cancer Institutes stated, “Long-term survival is identical with breast conserving surgery and radiation therapy, compared with mastectomy.”
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