Lumpectomy

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

During a lumpectomy, your surgeon works to make sure there is a cancer-free, or clear, margin of healthy tissue all around the removed cancerous tissue to reduce the risk of cancer returning (recurring) in the same area later. 

If your post-surgery pathology report shows that the margins were not clear, your surgeon may recommend an additional procedure called a re-excision to achieve clear margins.

A lumpectomy 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.

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

Who is eligible for a lumpectomy?

Eligibility for breast conserving surgery is based on many factors, including tumor size and location.

If you’ve been offered a choice between mastectomy or lumpectomy plus radiation, and you’re concerned about losing a breast, a lumpectomy may be a good option. Choosing this procedure 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 administered daily for several days or weeks, depending on the type of radiation given.

A growing number of studies report that people who have the option to choose lumpectomy experience higher sexual well-being than those who have mastectomy and reconstruction. Some reasons for this include:

• Mastectomy may cut the nerves that provide sensation in the breast.
  In some cases, the nipple, which also provides sexual sensation, has to be removed as part of mastectomy.

Lumpectomy may not always be possible, but it is important to know that nerve and nipple-sparing techniques are being used to improve the quality of life after mastectomy, when the breast cannot be spared.

Research shows that doctors do not always bring up sexual health and well-being. It's important to ask your doctor about this as you are choosing whether to have lumpectomy or mastectomy. If you are not comfortable discussing sexual health concerns with your doctor, ask to be referred to your hospital social worker or your nurse navigator. They may be able to provide support for this discussion.

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

• The tumor measures less than 5 centimeters
  • For larger areas of cancer, oncoplastic lumpectomy may be an option if it’s available in your area.
  • If chemotherapy or hormonal therapy is given first, a larger cancer may be able to shrink to a size that can be removed with 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 undergo radiation therapy. Radiation therapy usually requires treatments 5 days a week.

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 relative to your breast size, 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 which procedure 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.

On your surgery date

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 will check in at the hospital and be taken to a holding area, where you can change into a surgical gown.

If the cancer cannot be felt through the skin or if a marker was placed in the cancerous area, your radiologist or surgeon will locate it just before surgery. To locate it, they can use imaging and a needle-guided wire or a wireless probe that detects the marker.

In wire localization, a radiologist uses imaging and a needle to insert and guide a wire into the breast where the marker is. The needle is then removed, and the wire is left inside of the breast and partially sticking out of the breast. This procedure is always done on the day of surgery due to the risk of wire dislodgement if a person were to go home with a wire in the breast.

It’s important to know that wire localization can be painful for some women, and surgery schedules usually require waiting in a holding area with the wire inserted, sometimes for several hours, before entering the operating room.

Wire-free localization does not have these risks or requirements. Instead, the surgeon uses a wire-free probe to locate a marker. This is usually done once you are asleep in the operating room.

If you have concerns about the type of localization your hospital uses, talk with your healthcare team. You can learn more about wire and wire-free localization on the Surgery page.

If your surgeon will also be performing a sentinel lymph node biopsy, blue dye and/or radioactive substance will be injected into your breast before you’re taken into the operating room. The dye or substance will identify the lymph node or nodes that the cancer is most likely to drain to first.

Shortly before the procedure, 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 a lumpectomy?

This procedure 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 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 or other x-ray visible (radioopaque) stitches 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 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 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 surgical 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.
  • If you have weakness or mobility issues in your arms or shoulders before surgery, ask your doctor about a physical therapy consult BEFORE surgery. This provides an opportunity to begin strengthening your arms and legs, increase range of motion and mobility, and establish a relationship with your physical therapist to track your progress before and 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 a lumpectomy. 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 a lumpectomy 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 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 margins at your hospital.

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 the hormones estrogen and progesterone are helping the cancer cells to grow

Re-excision s lumpectomy

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.