Lumpectomy - Breast Cancer.org

Lumpectomy (also called breast-conserving surgery) is surgery to remove a breast cancer tumor (the lump) and the rim of healthy tissue ... AboutyouNewlydiagnosedIntreatmentFinishedmytreatmentLivingwithmetastaticdiseaseConcernedaboutmyriskCaringforsomeoneLearnBycategoryAboutbreastcancerTypesofbreastcancerSignsandsymptomsTreatmentoptionsSideeffectsManaginglifewithcancerBytypeResearchnewsPersonalstoriesPodcastepisodesVideosSurgicalimagegalleryCommunityDiscussionforumJoinourcommunityAlltopicsActivetopicsFindmembersSearchUsefulresourcesDiscussionforumguidelinesGuidetocommonabbreviationsNeedhelpfromourmoderators?DonateTreatmentOptions/SurgeryLumpectomyLumpectomy,alsocalledbreast-conservingsurgery,isaprocedurethatremovesthebreastcanceralongwithasmallamountofthehealthytissuesurroundingit.Reviewedby2medicaladvisersAdvertisementSectionsLumpectomyplusradiationtherapyWhattoexpectwithlumpectomyGettingyourpathologyresultsRe-excisionlumpectomyLumpectomyrisksQuestionstoaskyoursurgeonaboutlumpectomyOncoplasticlumpectomyandreconstructionafterlumpectomyPartialbreastformsAdvertisementLumpectomy(alsocalledbreast-conservingsurgery)issurgerytoremoveabreastcancertumor(thelump)andtherimofhealthytissuesurroundingit(calledthemargin). AdvertisementUnlikemastectomy,whichremovestheentirebreast,lumpectomyremovesonlythecancertopreserveasmuchofyourbreastaspossible.AdvertisementBecauseonlypartofthebreastisremoved,lumpectomyisalsosometimesreferredtoasapartialmastectomy.Theamountoftissuethesurgeonremovescanvarygreatly.Thefollowingproceduresareconsideredformsoflumpectomy: AdvertisementAdvertisementwedgeresection,inwhichalargerwedgeoftissueisremovedAdvertisementquadrantectomy,inwhichroughlyaquarterofthebreastisremovedAdvertisementRemovingamarginofhealthytissuesurroundingthecancerhelpsensurethatthesurgeonremovesallofthecancer.Duringlumpectomysurgery,somesurgeonsuseatechniquecalledcavityshavemargins:Surgeonsshaveathinlayeroftissuefromthesidesoftheareafromwheretheyremovethetumorsonocancercellsareleftbehind. AdvertisementDuringalumpectomy,thesurgeonalsousuallyremovesonetothreeunderarmlymphnodes.Removingtheselymphnodesisknownasasentinellymphnodebiopsy.Adoctorcalledapathologistexaminestheselymphnodestocheckforanysignsofcancer.Ifthepathologistfindscancer,youmayneedtohavemorelymphnodesremovedthroughaprocedurecalledaxillarylymphnodedissection.AdvertisementIfyou’reconsideringlumpectomy,it’sagoodideatotalktoyoursurgeonabouthowmuchtissueneedstoberemovedandhowitmightaffectyourbreast'sappearance.Insomecases,surgeonscanuseplasticsurgerytechniquesduringthelumpectomytoachieveabettercosmeticresult.Calledoncoplasticlumpectomy,thisapproachmaymakebreast-conservingsurgerypossibleevenifyouhavealargertumorormultipleareasofcancer.Advertisement LumpectomyplusradiationtherapyAdvertisementDoctorstypicallyrecommendradiationtherapyafterlumpectomytohelpreducetheriskofthecancercomingback(recurrence).Thegoalofradiationtherapyistodestroyanycancercellsthatmightremaininthebreastafterthesurgeonremovesthetumor.AdvertisementResearchshowsthat,formostwomenwithearly-stagebreastcancer,lumpectomyplusradiationoffersbettersurvivalthanmastectomy.Early-stagebreastcanceriscancerthathasn’tspreadbeyondthebreastorunderarmlymphnodes.AdvertisementBackin2002,theinfluentialNSABP-06Trialfoundthatafter20yearsoffollow-up,totalmastectomydidnotofferanadvantageoverlumpectomyintermsofhowlongwomenlived(overallsurvival),howlongtheyremainedfreeofrecurrence(disease-freesurvival),andwhethertheydevelopedmetastaticdisease(cancerspreadingbeyondthebreast). 1AdvertisementOtherstudieshaveconfirmedthoseresults:AdvertisementAdvertisementA2013studyofmorethan112,000womenwithstageIorstageIIbreastcancerfoundthatoverallsurvivalanddisease-freesurvivalwerehigherforwomenwhohadlumpectomyplusradiationthanforthosewhohadmastectomy. 2AdvertisementA2014analysisofover132,000womenfoundthatfive-and10-yearbreastcancer-specificsurvivalrateswerehigherforwomendiagnosedwithearly-stagecancerwhohadlumpectomyplusradiationthanforthosewhohadmastectomy. 3AdvertisementA2021studyofnearly49,000womendiagnosedwithearly-stagebreastcancerinSwedenfoundthatoverallsurvivalandbreastcancer-specificsurvivalrateswerehigherforthosewhohadlumpectomyandradiationthanforthosewhohadmastectomywithorwithoutradiation.AdvertisementWhenchoosingthetypeofradiationtherapyandaschedulethatmakessense,youandyourdoctorsconsideryourindividualsituation,yourage,andthecancer’scharacteristics.Examplesinclude:AdvertisementAdvertisementExternalwhole-breastbeamradiation:Traditionally,peoplereceivedthisformofradiationfivedaysaweekforfivetosevenweeks.Anewer,morecommonapproachistohavethesamedoseofradiationinjustthreetofourweeks,whichiscalledanacceleratedorhypofractionatedradiationschedule.AdvertisementAcceleratedpartial-breastradiation:Duringaone-totwo-weekperiod,peoplereceivealargerdoseofradiationdirectlytothepartofthebreastwherethecancerwas—insteadoftotheentirebreast.Certainwomendiagnosedwithearly-stagebreastcancermaybecandidatesforthisformofradiation.AdvertisementBrachytherapyorinternalradiation:Brachytherapyusesradiationintheformofpelletstodestroycancercellsandshrinktumors.Thepellets(alsocalledseeds)areplacedintheareawherethecancerwaswithanapplicatordeviceortinytubes(calledcatheters).Thepelletsemitradiationintothesurroundingtissue.Peopleusuallyreceivethistreatmenttwiceadayforfivedays.AdvertisementIntraoperativeradiationtherapy(IORT):Peoplereceivethistypeofradiationtherapyduringlumpectomysurgery,rightafterthesurgeonremovesthecancer.Althoughtheunderlyingbreasttissueisstillexposed,asinglehighdoseofradationisgivendirectlytotheareawherethecancerwas.HypofractionatedRadiationTherapyDec.5,202000:00ShareListenonDownloadVisitepisodepageformoreinfo00:00AdvertisementRadiationtherapyisn’tusuallyrecommendedforcertaingroups,including: AdvertisementAdvertisementpeoplediagnosedwithDCIS(ductalcarcinomainsitu)thathasalowriskofrecurrenceAdvertisementwomenolderthanage65diagnosedwithearly-stage,estrogenreceptor-positivebreastcancer LearnmoreRadiationTherapy Islumpectomyplusradiationrightforyou?AdvertisementYourdoctorcanhelpyoudecidewhichsurgeryisbestforyouruniquesituation.Lumpectomyplusradiationtherapymayberightforyouif:AdvertisementAdvertisementyouhaveonetumorthatisrelativelysmallcomparedwiththesizeofyourbreast AdvertisementyouprefertokeepasmuchofyournaturalbreasttissueaspossibleAdvertisementyouwanttoavoidmastectomyandreconstruction,whichisamoreinvolvedprocessAdvertisementyou’reabletocommittodailyradiationtreatmentsforaperiodofafewweeksAdvertisementWithsomeexceptions,youmaynotbeacandidateforlumpectomyplusradiationif:AdvertisementAdvertisementyou’vealreadyhadradiationtothesamebreastforanearlierbreastcancerAdvertisementyouhavealargeamountofcancerinthebreastormultipleareasofcancerinthesamebreast Advertisementyouhaveasmallbreastandalargetumorandremovingthetumorwouldbeextremelydisfiguring(andoncoplasticlumpectomyisn’tanoptionforyou)Advertisementyouhaveinflammatorybreastcancer,whichrequiresmastectomyAdvertisementyouhaveaconnectivetissuediseaseinvolvingtheskin,suchassclerodermaorlupusAdvertisementyou’repregnant,whichmakesradiationtherapyunsafeAdvertisementyoucan’tcommittoadailyradiationtherapyscheduleAdvertisementyouhaveahigher-than-averageriskofdevelopingbreastcancerinthefuture,includingastrongfamilyhistoryoraconfirmedgeneticmutationassociatedwithincreasedbreastcancerriskAdvertisementyoursurgeonhasmadeseveralunsuccessfulattemptstoremovethebreastcancerwithlumpectomyAdvertisementAlthoughlumpectomyplusradiationisjustaseffectiveasmastectomyformostwomen,somewomendecidetohaveamastectomyforbetterpeaceofmindaboutfuturebreastcancerscreenings.AbouthalfofthewomenintheUnitedStateswhoareeligibleforlumpectomychoosemastectomyinstead,accordingtotheNationalCenterforHealthResearch(NCHR). 4Mastectomyisavalidchoiceifit’srightforyou,butit’simportanttomakeaninformeddecision.TheNCHRreportedthatwomenaremorelikelytohaveamastectomyiftheyhaveanoldersurgeon,aretreatedatacommunityhospitalinsteadofanacademicmedicalcenter,anddon’thaveaprivatehealthinsuranceplan.It’simportanttoexploreallofyourchoicessoyoucandecidewhethermastectomyisthebestoptionforyou.Advertisement WhattoexpectwithlumpectomyAdvertisementAlumpectomyistypicallyanoutpatientprocedure,whichmeansyougohomethesameday.Ifyou’reconsideringalumpectomy,therearethingsyoucanexpectbefore,during,andafterthesurgery.LearnmoreAdvertisement GettingyourpathologyresultsAdvertisementAfterlumpectomysurgery,youreceiveapathologyreportthatexplainsthebreastcancer'scharacteristics,suchas:AdvertisementAdvertisementthesizeofthetumorAdvertisementtumorgrade:ameasurementofhowmuchthecancercellsresemblenormal,healthycellsAdvertisementhormonereceptorstatus:whetherornotthebreastcancercellshavereceptorsforthehormonesestrogenandprogesterone,meaningthatthesehormonesaresignalingthecancertogrowAdvertisementHER2status:whetherthecellshavetoomanycopiesofageneknownasHER2,whichcanpromotecancercellgrowthAdvertisementmargins:whethertheyarepositiveornegativeAdvertisementlymphnodestatus:ifthesurgeonremovedlymphnodes,thereportsayshowmanynodes,ifany,havecancerinthemAdvertisementTheseandotherbreastcancercharacteristicshelpyouandyourdoctordecideonatreatmentplanthat'sappropriateforyou. LearnmoreUnderstandingYourPathologyReport Advertisement Re-excisionlumpectomyAdvertisementUpto20%ofpeoplewhohavelumpectomyrequireasecondsurgery—calledre-excisionlumpectomy—becauseofpositivemargins. 5AdvertisementAfterlumpectomy,thepathologistcarefullyexaminesallofthetissuethesurgeonhasremovedfromthebreasttoseeifcancercellsarepresentinthemargins—arimofnormal,healthytissuesurroundingthecanceroustumor.Thetumorandsurroundingtissuearerolledinaspecialinksothemarginsareclearlyvisiblewhenthepathologistchecksthinslicesofthesampleunderamicroscope.AdvertisementIftherearenocancercellsinthemarginsornoinkonthetumor,themarginsareconsideredtobenegative,clear,orclean.Iftherearecancercellsinthemarginsorinkonthetumor,themarginsareconsideredtobepositive.Togetcleanmargins,yoursurgeonmayrecommendmoresurgery,calledre-excisionlumpectomy.Somesurgeonsrefertore-excisionasclearingthemargins.Iftherearestillpositivemarginsafterre-excision,yoursurgeonmayneedtodoanotherre-excisionorperformamastectomy.AdvertisementSurgeonsfollownationalguidelinesfornegativemargins.AdvertisementAdvertisementGuidelinesforinvasivebreastcancerconsidermarginstobenegativewhenthereisnoinkonthetumorornocancerpresentinthetissuethesurgeonremoved.AdvertisementGuidelinesforDCISconsidera2-millimetermargintobenegative.AdvertisementGuidelinesforcaseswherethereisinvasivecancerandDCISconsidermarginstobenegativewhenthereisnoinkonthetumor. 6 7Advertisement LumpectomyrisksAdvertisementLikeallsurgeries,lumpectomycarriescertainrisks:AdvertisementAdvertisementSeroma:Aseromaisabuildupoffluidinthespacewherethesurgeonremovedtissuethattypicallyhappensaftersurgery.Insomecases,therecanbealargebuildupoffluidthathastobedrained.AdvertisementInfection:Thereissomeriskofinfectionattheincisionsite.Aninfectionoftheskin,knownascellulitis,candevelopinsomepeople.AdvertisementLossofsensation:Thereisusuallysomenumbnessandlossofsensationinpartofthebreastafterlumpectomy,dependingonthesizeoftheremovedlump.Someormostofthefeelingmayreturnovertime.AdvertisementScars,indentation,dimpling,andothercosmeticchanges:Lumpectomycanleadtocosmeticchangesthatbecomevisibleovertimeastheskinheals. AdvertisementUnevenbreasts:Yourbreastsmaynotbethesamesizeandshapeaseachotheraftersurgery.Theaffectedbreastcanlooksmallerafterlumpectomy.Youmaynotnoticethisrightawaybecauseswellingaftersurgerymightmakeyourbreasttemporarilyappearlarger.Radiationtherapyalsocanchangetheaffectedbreast’ssize.AdvertisementNervepain:Somepeopleexperienceburningorshootingpaininthearm,armpit,orchestwallthatusuallygoesawayintheweeksormonthsaftersurgery.Sometimesnervepainmaylastlonger.AdvertisementLymphedema:Ifthesurgeonremovedunderarmlymphnodes,youmaydeveloplymphedema.Thisbuildupoflymphfluidcancauseswellinginthearm,hand,orupperbody.Advertisement QuestionstoaskyoursurgeonaboutlumpectomyAdvertisementHerearesomequestionsyoumaywanttoask yoursurgeonasyoupreparefor lumpectomysurgery:AdvertisementAdvertisementHowmanytimesdoyouperformlumpectomyinanaveragemonth?Whatpercentageofyourpatientsrequirere-excision?AdvertisementHowdoyouknowwhetheryouhaveachievedcleanmargins?Doyouuseanytechnologyduringsurgerytohelpensurecleanmargins?AdvertisementDoyouusetheshavemarginstechnique(whichmeansshavinganotherthinlayeroftissuefromtheareaaroundthetumor)? AdvertisementWhataretherisksoflumpectomy? AdvertisementHowshouldIprepareforlumpectomysurgery?AdvertisementHowlongdoesalumpectomytake?AdvertisementHowbigisthetumorrelativetomybreastsize?Howmuchtissuedoyouneedtoremove?AdvertisementDoyouexpecttoremoveanyunderarmlymphnodes(sentineloraxillarynodedissection)alongwiththetumor?AdvertisementAreyouabletohidethescarandrearrangethetissuetominimizeanydentsorothercosmeticissues(oncoplasticlumpectomy)aftersurgery?Ifnot,canyoucallinaplasticsurgeon?AdvertisementIfIneedtohavealargerportionofbreasttissueremoved(20%ormore),areyouabletoperformanoncoplasticlumpectomytoreduceorliftthebreastandbringtheotherbreastintobalance?Canyouworkwithaplasticsurgeon?AdvertisementWhatkindofanesthesiacanIexpecttohave?AdvertisementHowcanIexpectmybreasttolookafterlumpectomy?Willmybreast’sappearancechangeovertime?AdvertisementWhatisthelikelyeffectofradiationtherapyonmybreastafterlumpectomy?AdvertisementDoIneedtostayovernightinthehospitalaftersurgery?AdvertisementHowlongdoesittaketorecover?AdvertisementArethereanyprecautionsIshouldtakeasIrecover?CanIgetwritteninstructionstofollow?AdvertisementHowshouldIcareforthesurgicalsiteanddressings?WillIneedasurgicaldrainafterward?Ifso,howshouldIcareforit?AdvertisementArethereexercisesIshoulddoaftersurgery?AdvertisementWhencanIreturntomynormalroutineandactivities?AdvertisementWhatismyriskfordevelopinglymphedemaaftersurgery?AdvertisementIfIamnothappywiththeappearanceofmybreastsafterafewmonthshavepassed,whatoptionsdoIhave?Advertisement OncoplasticlumpectomyandreconstructionafterlumpectomyAdvertisementLumpectomycancausecosmeticchangestothebreast,suchasvisibleindentation,atightscar,ordistortionsinthenipple’sappearance.Anycosmeticchangescandependonthecancer’ssizeandlocation,aswellasthesizeofyourbreastcomparedtothetumor’ssize.Radiationtherapyafterlumpectomycanalsoaffectthebreast’sappearance,includingitssizeandshape,leadingtounevenbreasts(asymmetry).Unevenbreastsmightnotbecomeobviousuntilmonthsaftersurgeryandalsocanbeaffectedbyweightgainorloss.AdvertisementYourreconstructionoptionsincludeoncoplasticlumpectomyandreconstructionafterlumpectomy:AdvertisementOncoplasticlumpectomytechniquescanhelpminimizescars,indentation,dimpling,orothercosmeticchangesthatmayresultafterlumpectomy.Oncoplasticlumpectomyalsocanhelpbreastslookeven,especiallyifthesurgeonneedstoremovealargeamountoftissue.Forexample,surgeonscanoperateontheotherbreasttohelprestoresymmetry—butsomewomendecidetouseapartialbreastshaperinstead.AdvertisementIfyouaren’thappywiththewayyourbreastslookafteratleastsixmonths,youmaywanttoconsiderrevisionreconstructionsurgerywithaplasticsurgeon.Optionsincludefatgraftingortissuetransfertofillindentsordivotsortoremedyscarringorhardening.Thesurgeoncanuseatissueflaporimplantiftheaffectedbreastisdistortedorshrunken.Aplasticsurgeonalsocanoperateontheotherbreasttomakesurebothbreastsareeven.Advertisement PartialbreastformsAdvertisementSomepeoplewhohaveunevenbreastsafteratraditionallumpectomymaynotnecessarilywanttohavereconstructivesurgery.Inthesecases,apartialbreastform(orprosthesis)canhelpachieveamoreevenappearance.AdvertisementManyofthemanufacturerswhomakefullbreastformsforuseaftermastectomyalsomakepartialforms,sometimescalledpartialbreastshapers.Thesearesiliconebreastformsavailableindifferentshapesandsizesthatyoucanattachdirectlytotheskinwithadhesiveorplaceinsideapost-mastectomybrawithpockets. AdvertisementAcertifiedmastectomyfittercangiveyouabetterideaaboutthefullrangeofprostheticoptionsandensureyougetthebest-fittingformsforyou.Certificationmeansthatthefitterhascompletededucationandtraininginfittingbreastforms,completedmanyhoursworkingwithpatients,andpassedaexam.Manycancercentershavein-houseboutiqueswithcertifiedfitters.Somespecializedlingerieshopsanddepartmentstoreshavecertifiedfittersonstaffaswell.TheAmericanCancerSociety’sReachtoRecoveryprogramisalsoagoodresource.AdvertisementMosthealthinsuranceplansoffercoverageforbreastformsandbrasaftermastectomyandafterlumpectomy.Still,it’sagoodideatocheckyourhealthinsurancecompany’swebsiteorcallarepresentativetofindoutexactlywhatyourplancovers.Tobeeligibleforhealthinsurancecoverage,youneedaprescriptionfromyourdoctorforthebreastformandbra.AdvertisementSomewomenprefertouselightweightbreastformstoaddmorevolumeandshapetoasmallerbreast.Thesebreastformsaretypicallymadeoffoam,polyurethane,orpolyesterandcanbeslippedinsideapost-mastectomybrawithpockets.Youcanfindthesetypesofbrasatvariousplaces,includingAthleta,AnaOno,andTheBustedTank.Inadditiontobeinglightweight,breastformsarefairlyinexpensive,washable,andeasytowearandreplace.Peoplewhopreferbreastformsalsosaytheyareespeciallycomfortabletowearwhentheyworkout. LearnmoreUnderstandingYourOptionsforBreastForms AdvertisementWrittenby:KristineConner,contributingwriter ReferencesFisherB,AndersonA,BryantJ,etal.Twenty-yearfollow-upofarandomizedtrialcomparingtotalmastectomy,lumpectomy,andlumpectomyplusirradiationforthetreatmentofinvasivebreastcancer.NEJM.2002.347(16):1233-41.Availableat:https://doi.org/10.1056/nejmoa022152HwangES,LichtensztajnDY,GomezSL,etal.Survivalafterlumpectomyandmastectomyforearlystageinvasivebreastcancer.Cancer.2013.119(7):1402-1411.Availableat:https://doi.org/10.1002/cncr.27795AgarwalS,PappasL,NeumayerL,etal.EffectofBreastConservationTherapyvsMastectomyonDisease-SpecificSurvivalforEarly-StageBreastCancer.JAMASurg.2014.149(3):267-274.Availableat:https://doi.org/10.1001/jamasurg.2013.3049 NationalCenterforHealthResearch.Mastectomyv.Lumpectomy:WhoDecides?Availableat:https://www.center4research.org/mastectomy-v-lumpectomy-who-decides/ Sharsheret.20%ofwomengettinglumpectomiesneedasecondsurgery,butthisriskcanbelowered.Availableat:https://sharsheret.org/20-of-women-getting-lumpectomies-need-a-second-surgery-but-this-risk-can-be-lowered/MoranMS,SchnittSJ,GiulianoAE,etal.SocietyofSurgicalOncology–AmericanSocietyforRadiationOncologyConsensusGuidelineonMarginsforBreast-ConservingSurgeryWithWhole-BreastIrradiationinStagesIandIIInvasiveBreastCancer.AnnSurgOncol.2014.21:704-716.Availableat:https://doi.org/10.1245/s10434-014-3481-4 MorrowM,VanZeeKJ,SolinLJ,etal.SocietyofSurgicalOncology–AmericanSocietyforRadiationOncology–AmericanSocietyofClinicalOncologyConsensusGuidelineonMarginsforBreast-ConservingSurgeryWithWhole-BreastIrradiationinDuctalCarcinomainSitu.PractRadiatOncol.2016.6(5):287-295.Availableat:https://doi.org/10.1016/j.prro.2016.06.011.—LastupdatedonJune24,2022,8:00PMReviewedby2medicaladvisers AnnePeled,MDSutterHealthCaliforniaPacificMedicalCenter,SanFrancisco,CAStephanieValente,DOClevelandClinicMollCancerCenteratFairviewHospital,Cleveland,OHLearnmoreaboutouradvisoryboardWasthisarticlehelpful?YesNoAdvertisement