Lumpectomy

Lumpectomy surgery is a breast-conserving treatment that removes cancer while allowing you to keep some or most of your natural breast tissue. Lumpectomy surgery is sometimes called partial mastectomy, because only a part of the breast is removed.

During lumpectomy surgery, your breast surgeon works not just to remove the cancer, but also to make sure there is a cancer-free, or clean, margin of healthy tissue all around the removed cancerous tissue to reduce the risk of cancer returning (recurring) in the same area later. The margin is sometimes called the margin of resection.

If cancer cells are found in the margin during examination later, your surgeon will likely recommend a second surgery to confirm a clean margin is removed where the cancer was. This is called re-excision lumpectomy or re-excision of margins.

Lumpectomy surgery is almost always followed by radiation therapy to further reduce the risk of recurrence in the remaining breast tissue. When looking at rates of recurrence and long-term survival, many studies have shown that lumpectomy plus radiation can be just as effective as mastectomy in treating early-stage breast cancer.

Lumpectomy surgery can leave a scar, a dent, or hardening in the breast. If you’re concerned about how your breast will look after lumpectomy surgery, ask your surgeon about oncoplastic lumpectomy, which uses plastic surgery techniques during lumpectomy to reduce visible scarring or indentations. These techniques can also be used at some point after lumpectomy to make corrections. Oncoplastic lumpectomy is not available at every hospital. If it’s not available where you are, breast reconstruction techniques can also be used to correct imbalances left after lumpectomy.

Who is eligible for a lumpectomy?

Eligibility for lumpectomy surgery is based on many factors, including tumor size and location. If you’ve been offered a choice between mastectomy or lumpectomy surgery plus radiation, and you’re concerned about losing a breast, lumpectomy may be a good option. Choosing lumpectomy surgery usually means that you also need to be able to make it to appointments for radiation therapy, which typically begins about a month after surgery and is given every day for several days or weeks, depending on the type of radiation given.

You may be a good candidate for lumpectomy surgery plus radiation therapy if:

• The tumor measures 5 centimeters (2 inches) or less.
  • For larger areas of cancer, oncoplastic lumpectomy may be an option if it’s available in your area.
  • If chemotherapy or hormone therapy is given first, a larger cancer may be able to shrink to a size that makes a patient eligible for lumpectomy.
• Your breast is large enough compared to the size of the tumor, leaving your breast generally balanced after surgery.
• Multiple areas of cancer are located in the same section of the breast (multifocal disease).
• You are willing and able to get to radiation therapy appointments in the weeks after lumpectomy.

Lumpectomy surgery plus radiation might not be a good option for you if:

• You are pregnant and would need to have radiation therapy right away, since radiation can harm an unborn baby. (If radiation can wait, you may still be a candidate.)
• You have inflammatory breast cancer, an aggressive type of cancer that involves the skin.
• You have a larger tumor, or you have cancer in multiple areas of the breast.
• You’ve had lumpectomy surgery and radiation therapy for breast cancer in the past. Radiation therapy can’t be given again to the same area.
• You’ve tested positive for an inherited genetic mutation that puts you at high risk for a future breast cancer, such as BRCA1, BRCA2, ATM, PALB2, and others, or if you have a strong family history of breast cancer without a positive genetic test result. Testing positive or having a strong family history does not mean that you can’t have a lumpectomy, though. Even though many people in this situation do seek mastectomy, talk with your doctor and genetic counselor about whether lumpectomy or mastectomy is a better option for you.
• You have a connective tissue disorder, such as scleroderma or lupus, which can make you more sensitive to the impact of radiation therapy.
• You feel strongly that you would have greater peace of mind if you went ahead with mastectomy.

What to expect before lumpectomy surgery

In the weeks and days before lumpectomy surgery, you’ll meet with your breast surgeon to talk about the procedure and how best to prepare. If you’re having oncoplastic lumpectomy and a plastic surgeon will be involved, you will also meet with the plastic surgeon to review the surgical plan.

Your breast surgeon will also let you know if you need to have lymph nodes removed to be checked for any signs of cancer. If lymph nodes need to be removed with sentinel node biopsy or axillary dissection, it’s important to talk with your surgeon about managing the risk of lymphedema, a swelling condition that can sometimes be a side effect of lymph node surgery. The risk of lymphedema is lower with sentinel node biopsy.

As you’re planning your surgery, you can also ask your surgeon about different approaches they may use. These may include oncoplastic techniques, which can hide the scar and rearrange tissue to fill the space left after cancer removal, and/or perform a breast reduction or lift on both breasts after a segment of the affected breast is removed.

It’s important to know that even if oncoplastic techniques are not available at your hospital, there are plastic surgery options that can work to correct imbalances after lumpectomy and/or radiation therapy. If this is a concern for you, ask your breast surgeon for a referral to a plastic surgeon with experience in breast reconstruction to talk about options.

As the surgery date gets closer, your care team will review any medicines or supplements you’re taking and recommend imaging and blood tests:

• If you’re on blood thinners or aspirin, your surgeon may recommend stopping those medications several days before surgery to reduce the risk of bleeding.
• Some herbal supplements can affect blood pressure or heart rhythm during surgery. Your surgeon will let you know if you need to stop taking any supplements in the days or weeks before surgery.
• You will also be given imaging and blood tests to check lung, heart, liver, and kidney function, as well as risk of infection.

If the cancer is too small to be felt through the skin, you may need to have a procedure using localization techniques with a seed a few days before lumpectomy. In this procedure, a radiologist places a tiny seed in the breast to mark the cancerous area. Your surgeon can then easily find the cancer using a small detection device. Or, on the day of surgery, a radiologist can mark the area using a thin wire (wire localization) or needle, guided by either a mammogram or ultrasound. If the lump can be felt through the skin, your surgeon or nurse can mark the area with a felt-tip pen.

You will need to stop eating and drinking about 8 to 12 hours before surgery if you are having general anesthesia, which is typically used for lumpectomy surgery.

On the day of surgery, you’ll check in at the hospital and be taken to a holding area, where you can change into a surgical gown. If your surgeon will also be performing a sentinel lymph node biopsy, dye or radioactive tracer will be injected into your breast before you’re taken into the operating room. The tracer will identify the lymph node or nodes that the cancer is most likely to drain to first.

Once the lumpectomy area is marked, an intravenous line will be placed in your hand or arm, and you will be given anesthesia. Lumpectomy surgery can include general anesthesia, which means you’re completely asleep or moderate sedation with local anesthesia to numb the area.

What happens during lumpectomy surgery

Lumpectomy surgery usually takes about an hour. If you’re having plastic surgery at the same time (oncoplastic lumpectomy), the procedure will take longer, especially if it involves having a breast reduction and/or lift on both sides.

Your breast surgeon will make an incision and remove the cancerous area and a small margin of healthy tissue surrounding it. Usually this is done with an electrocautery knife, which is an electric scalpel that uses heat to minimize bleeding.

The surgeon will often place small marking clips in the area where the cancer was to help guide radiation treatments. Then, the breast tissue is sewn back together with dissolvable stitches.

If you and your surgeon planned for lymph node removal along with lumpectomy surgery to check for cancer in the lymph nodes, you will either have sentinel lymph node biopsy and/or axillary lymph node dissection.

• Before a sentinel lymph node biopsy, the surgeon injects some dye and/or a small amount of radioactive tracer into the breast before you’re taken into the operating room. The injected material helps identify the nodes that are draining lymph from the area where the cancer was found. The surgeon then removes the node or nodes identified by the tracers. This is the lymph node removal procedure that’s used most of the time.
• During axillary lymph node dissection, a group of lymph nodes are removed from under the arm.

With both lymph node surgeries, the nodes are removed and sent to the pathologist for closer examination, along with the cancerous tissue removed from the breast.

Depending on the extent of your surgery, you may need to have a surgical drain kept in place to remove excess fluid from the surgery site. This is a small, flexible, plastic or rubber tube that drains fluid from the site as it heals. You can ask your surgeon if you’re likely to need surgical drains as part of your lumpectomy or axillary surgery.

What to expect after lumpectomy surgery

After the surgery, you’ll be moved into the recovery room, where your heart rate, blood pressure, body temperature, and breathing will be monitored until your care team says it is safe for you to be discharged. Most people who have lumpectomy surgery don’t need to stay overnight in the hospital. Your team will also provide instructions for managing any pain with over-the-counter medications such as Tylenol (acetaminophen) or prescription pain medication. They also will provide instructions about what to expect during your recovery at home.

If you had lymph node surgery, you will be given instructions on how to gently exercise your affected arm to help it recover.

Recovery

Typically, it takes about 2 weeks to recover from lumpectomy surgery and get back to your normal activities. (If you had more extensive surgery — such as removal of multiple lymph nodes, and/or oncoplastic lumpectomy that involved a breast reduction or lift — recovery will take longer). Your care team should provide instructions about what you need to do at home, such as:

• Take pain medications — whether prescription or over-the-counter medicines — and possibly antibiotics. You can ask about dosage and timing for each medicine, and how long you should take them.
• Care for your surgical incision and dressing. Your team should tell you about possible signs of infection, such as redness, discharge, or fever, and who to call if these happen. They will also tell you how to care for your incision and when the bandaging can be removed. Ask when you will be able to shower and if you can wear a comfortable sports bra (no underwire). In most cases, surgeons use sutures that dissolve on their own. Some surgeons use Steri-strips or Dermabond glue. These may either come off on their own, or your team will remove them. If you had traditional stitches, ask when they will be removed.
• Care for your surgical drain. If a drain was placed in your body during surgery, you should receive instructions on how to empty the detachable bulb that captures any fluid that drains from the surgical site. Your team will also explain that you or your caregiver will need to measure the fluid, and write down the amount of fluid each time the bulb is emptied. You’ll be asked to share this information with your nurse or doctor to make sure the incision is draining properly.
• Safely exercise your arm to prevent stiffness. Ask about when and how to start exercising your arm safely and gently to help with recovery. Your care team should give you written, illustrated instructions on how to perform these exercises. They should also tell you what activities to avoid (such as lifting or pulling) and when it is safe to resume them.

To learn more, visit Recovering after surgery.

Side effects

Although each person’s body responds to surgery differently, here are some common side effects that can happen after lumpectomy surgery:

• Pain or tenderness in the breast
• A change in breast shape
• Temporary swelling as the breast heals
• Seroma, a usually temporary buildup of fluid in the space left behind after surgery; if a seroma doesn’t resolve on its own, your doctor can remove the fluid through a fine needle
• Scarring, hardening, or dimpling in the area where the cancer was removed

Some people may experience pain in the chest area, armpit, or arm after lumpectomy surgery. The pain can feel like a tingling, burning, or shooting sensation. It may go away over time, or it may persist — a condition known as post-mastectomy pain syndrome, which can also happen after lumpectomy surgery. Some people experience other symptoms such as numbness or itching. If you have these symptoms, let your care team know. There are treatments and management strategies available.

If underarm lymph nodes are removed with sentinel lymph node biopsy or axillary lymph node dissection, there can be a risk for lymphedema, a swelling condition in which lymph fluid can build up in the arm, hand, or areas near the surgical site. There are many ways to lower the risk of lymphedema. Visit our lymphedema section to learn more.

Radiation therapy given after lumpectomy surgery can also have side effects. Specific side effects depend on the type of radiation you receive, but can include:

• Skin dryness, redness, and irritation
• Temporary swelling in or around the breast
• Scar tissue development years after radiation therapy

Not everyone experiences every side effect. Talk with your care team about what to expect and how to care for the affected breast after lumpectomy surgery and radiation therapy, and read more about ways to manage these side effects.

You can also watch surgical oncologist Monique Gary, DO, MSc, FACS explain ways to protect your skin before, during, and after surgery and radiation therapy in this video interview:

Receiving your lumpectomy pathology report

Within a few days to a week, you can expect to receive a pathology report. The report will tell you if the surgeon achieved clear surgical margins, which means that there is healthy tissue surrounding the cancer in the entire area that was removed. Different hospitals have different standards for what they consider to be acceptable margin measurements:

• For example, while a margin of 2 millimeters has been found to reduce the risk of recurrence in women with ductal carcinoma in situ (DCIS) who receive lumpectomy surgery plus radiation therapy, some hospital standards say that 1 millimeter, or even less, is enough of a clean tissue margin to reduce risk of recurrence.
• For invasive forms of breast cancer, guidelines state that margins are considered clear as long as there is no cancer at the very edge of the area that was removed. This is also known as “no tumor on ink.”

Ask your surgeon what the measurement standards are for clean lumpectomy margins at your hospital.

If the margins are not clear, you may need to have a repeat surgery, also called a re-excision lumpectomy. Studies suggest that roughly 1 in 4 women will need to have more surgery after their initial lumpectomy to achieve clean margins.

The pathology report also will have information about other characteristics of the cancer that can help you and your doctor make decisions about additional treatment. Examples include:

• Tumor size
• Cell grade, or how abnormal the cells look and how fast-growing they are
• Hormone receptor status, which tells you whether or not the hormones estrogen and progesterone are helping the cancer cells to grow

Learn more in Your pathology report.

Treatment after lumpectomy surgery

After your lumpectomy surgery, your care team will make additional treatment recommendations based on the characteristics of the cancer. These treatments are given to reduce the risk of recurrence. Options include:

• Radiation therapy. Nearly everyone who has lumpectomy surgery needs to have radiation therapy to the breast to destroy any cancer cells that might have been left behind. You and your radiation oncologist will work together to decide on the type of radiation that works best for your situation. Types of radiation therapy include:
  • External beam radiation (EBRT), the most commonly given radiation therapy, which can be directed at the whole breast or part of the breast
  • Brachytherapy, which uses a tiny balloon or hollow flexible tube inserted into the area where the tumor was to deliver radiation

Another type of radiation treatment, called intraoperative radiation therapy (IORT), can be given in one large dose during or after lumpectomy surgery. However, IORT is not widely available, and has a higher risk of post-treatment recurrence than EBRT.

You and your radiation oncologist will also decide on a radiation treatment schedule that can work for you. A typical schedule is 5 days a week for 3 to 5 weeks, although you may be eligible for a shorter course of treatment. To learn more, visit Radiation therapy for breast cancer.

• Hormonal therapy. If the breast cancer cells removed during your lumpectomy surgery test positive for receptors to the hormones estrogen or progesterone, it means that one or both of these hormones is helping the cancer to grow. Your care team will likely recommend hormonal therapy, which involves taking medicine to lower the amount of estrogen in the body or to block estrogen’s impact on breast cells. The most common examples are tamoxifen and a class of medicines known as aromatase inhibitors, which are typically prescribed for 5 to 10 years. There are also other treatments that suppress the function of the ovaries, the body’s main source of estrogen before menopause. Your care team will talk with you about hormonal therapy options, based on the results of hormone-receptor testing and whether you are premenopausal or postmenopausal. To learn more, visit Hormonal therapy.
• Chemotherapy. Chemotherapy medicines are taken intravenously (through a vein) or by mouth to destroy cancer cells that are growing and dividing quickly. Chemotherapy works to reduce the risk of cancer recurrence. Your care team may recommend genomic testing to better understand your risk of cancer recurrence. Genomic testing can determine whether chemotherapy can help lower your risk of recurrence. A recommendation of chemotherapy is also based on certain characteristics of the cancer, such as tumor size, grade, and whether cancer cells were found in the underarm lymph nodes. To learn more, visit Chemotherapy.
• Targeted therapy. Targeted therapies are treatments that target specific features of cancer cells, such as proteins or markers, that help the cancer to grow. For example, some breast cancers test positive for a protein called HER2. This means that the cells make too many HER2 proteins, which tell the cancer cells to multiply. HER2-targeted medicines can attach to HER2 proteins on the inside or outside of a cancer cell and block signals that tell the cells to multiply too quickly. Targeted therapies can also work in other ways, targeting specific processes in the body that help cancer to grow. These medicines can be used alone or with other targeted therapies, hormonal therapies, or chemotherapy medicines. Learn more about Targeted therapy.