What Is a Lumpectomy? About This Breast Cancer Surgery

BCRF shares what a lumpectomy is, why it’s performed, and what the lumpectomy recovery process is like

Surgery is often part of a breast cancer treatment plan. And for many years, the only surgical option patients had was mastectomy, which removes the entire breast. But thanks to research, an increasing number of breast cancer patients now have the option to instead undergo a less-invasive lumpectomy, wherein the surgeon removes only a portion of breast tissue, typically followed by radiation.

While the introduction of lumpectomies is considered a major advancement in breast cancer treatment, women who can choose between lumpectomy surgery or a mastectomy often fear that a lumpectomy may be less effective at treating their cancer and preventing it from coming back. But what’s the real story? Below, you’ll learn more about the procedure, its pros and cons, and why a breast lumpectomy plus radiation is a safe alternative to mastectomy for many women.

What is a lumpectomy?

A lumpectomy is a type of breast cancer surgery to remove a tumor. The surgeon also removes a small amount of healthy tissue (margin), which helps ensure that all the cancer has been excised (cut out). Lumpectomy surgery is also referred to as breast-conserving surgery or partial mastectomy because the surgeon leaves behind as much healthy breast tissue as possible.

In some cases, the surgeon performs an additional procedure during a breast lumpectomy. He or she may remove axillary (underarm) lymph nodes during a lumpectomy to determine whether the cancer has spread to them. And if you decide to have breast reconstruction surgery—referred to as lumpectomy reconstruction or partial breast reconstruction—a surgeon may be able to perform it at the same time as your lumpectomy.

Lumpectomy surgery usually takes one to two hours, though the procedure may last longer if you’re also getting breast reconstruction. Lumpectomies are sometimes performed in a doctor’s office, but they usually take place in a hospital or surgery center. Depending on the extent of the surgery, you may need general anesthesia or light sedation with a local anesthetic to numb the surgical site.

Why are lumpectomies performed?

Lumpectomy surgery is most often performed to treat breast cancer. A lumpectomy may be the first step in your treatment plan and is followed by radiation. Or it may follow other forms of therapy used to shrink the tumor such as chemotherapy. A lumpectomy is more likely to be indicated if your tumor is smaller than 2 inches and small relative to the size of your breast.

What stage of breast cancer can be treated with a lumpectomy? The procedure may be an option for women with non-invasive ductal carcinoma in situ (also known as stage 0 breast cancer) or invasive breast cancer at stages 1 or 2. Once your cancer has reached stage 3, your doctor is more likely to recommend a mastectomy over a lumpectomy since the tumor is larger and/or has spread to nearby tissues. However, lumpectomy surgery may be a possibility at stage 3 if you have large breasts with no cancer spread.

Less often, a breast lumpectomy is performed to diagnose breast cancer. This type of lumpectomy surgery is referred to as an excisional biopsy. The surgeon removes a sample of tissue from the suspicious area in the breast and sends it to a lab to determine if cancer cells are present. If they are, additional tests may be performed to identify the type of breast cancer and how fast it’s growing.

A lumpectomy is typically not a good option if:

• You’re unable to undergo radiation, since a lumpectomy is almost always followed by radiation. This can be an issue if you’re pregnant and want to avoid exposing the fetus the radiation, or if you have a connective tissue disease like scleroderma or Sjögren’s syndrome that makes you more sensitive to the effects of radiation.
• The cancer has spread throughout your breast or if the tumor is large.
• You have breast cancer that’s recurred and was previously treated with a lumpectomy followed by radiation.
• You have more than one area of cancer in the breast, and they aren’t close to each other to remove them without significantly affecting the appearance of the breast.
• If you have inflammatory breast cancer or a breast cancer–associated genetic mutation (BRCA1, BCRA2, ATM, etc.) that may increase your risk of a second breast cancer.

What are the advantages and disadvantages of lumpectomy?

For many women diagnosed with breast cancer, the choice between undergoing a lumpectomy versus a mastectomy is difficult. But you are not alone in this decision. You and your doctor will work together to determine what’s best for you based on many factors. If a lumpectomy is an option, your doctor will explain the pros and cons of the procedure. These include:

Pros:

• A lumpectomy allows you to conserve more of your breast than a mastectomy, which you may prefer for cosmetic reasons.
• You’ll likely be able to keep the nipple and surrounding area.
• A lumpectomy preserves more sensation in the breast compared to a mastectomy.
• Recovery is shorter and easier.
• If you’re at average risk of breast cancer recurring, a lumpectomy plus radiation is a safe alternative to a mastectomy. While some women who have the option of getting a lumpectomy or mastectomy opt for the latter for peace of mind, studies show that undergoing more aggressive surgery doesn’t reduce the risk of recurrence or improve long-term survival benefits.
• Risks of breast surgery, such as pain, infection, and bleeding, are lower with a lumpectomy because it’s less invasive than a mastectomy.

Cons:

• As previously mentioned, lumpectomy typically requires radiation. If you’re unable to or don’t want to undergo radiation, lumpectomy, most likely, is not a good option.
• Results of lumpectomy surgery can be unpredictable. You may experience asymmetry or contour abnormalities such as dents depending on how much breast tissue is removed.
• You may ultimately need a mastectomy if you undergo a lumpectomy and subsequent re-excision and the pathologist still finds cancer cells in the margin.
• Because the entire breast isn’t removed, some women experience increased anxiety about breast cancer recurrence and thus prefer mastectomy.

What are the main types of lumpectomy?

Including excisional biopsy (mentioned above), there are four major types of lumpectomy surgery. The other three are:

Wide local excision. This is the most basic type of lumpectomy surgery. The surgeon makes an incision in the affected breast, usually in the area over the cancer, and removes the tumor and margins.

Quadrantectomy. More tissue—approximately a quarter of the breast—is removed during aquadrantectomy compared to wide local incision. This includes the tumor, larger margins, area containing your milk ducts, and sometimes overlying skin. Part of the lining of the chest wall may also be removed if the cancer is near the chest wall. Quadrantectomies are performed when the central part of the breast is involved. They are generally not used for early-stage breast cancers.

Re-excision of margins. If a wide local incision reveals the presence of cancer cells in the margin, you’ll undergo a re-excision of margins. The surgeon re-opens the lumpectomy incision and removes additional tissue to ensure all remaining cancer cells are gone.

How does lumpectomy change a breast’s appearance? 

While lumpectomy surgery allows you to keep as much of your breast tissue as possible, the cosmetic results may not be ideal. Some women may notice only minor differences, but others may experience a significant change in the size or shape of the breast or abnormalities such as dimpling or dents. This is more likely to occur if a large amount of tissue was removed.

If you choose to have the breast reconstructed, your surgeon may be able to do it during your lumpectomy. This procedure, called oncoplastic surgery, may include rearranging the breast tissue to fill in any gaps, relocating the nipples to make them more symmetrical, or performing a reduction or lift on both breasts so they match in size.

In some circumstances, your doctor may advise delayed reconstruction, which can take place months or years after a lumpectomy. Most are performed six months to a year following the lumpectomy and radiation treatments. Your surgeon may reconstruct the breast using fat taken from another part of your body (fat grafting), inserting an implant, or removing skin, fat, and sometimes muscle from other areas to create a breast shape (flap reconstruction.)

If you’re concerned about your breast’s appearance following your lumpectomy, talk to your doctor ahead of the procedure. He or she can give you an idea of what the breast might look like, and if you’re a candidate for breast reconstruction.

Why do I need radiation after lumpectomy? Doctors typically recommend radiation following lumpectomy surgery to kill any cancer cells that may remain and reduce the risk of recurrence in the affected breast. Typically, radiation treatments are directed to the entire breast (whole-breast irradiation), though targeting only part of the breast (partial-breast irradiation) may be an option for some women with early-stage breast cancers.

If you require whole-breast irradiation, it’s most often delivered externally from a machine, while partial-breast irradiation can be delivered externally or internally. Internal radiation is performed via a radiation-delivery device implanted in the area where breast tissue was removed. Once treatment is complete, your doctor removes the device.

What’s the lumpectomy recovery process like?

You can usually go home the same day as your surgery, so lumpectomy recovery mostly takes place at home. Elements of home care include:

• Cleaning the surgical site and changing your dressings. This is essential for preventing infection. Your doctor may advise you to clean the area with antibacterial soap (no rough scrubbing), avoid getting the dressing wet, and how often to change the dressing.
• Following a pain medication schedule. You will feel some discomfort during lumpectomy recovery, but you can usually manage it with over-the-counter (OTC) pain medication. Your doctor will tell you the proper dosage and how frequently you should take it.
• Emptying surgical drains. You may need to have surgical drains inserted into the armpit or breast area to remove fluid that collects in the area where the tumor was excised. If so, you’ll have to empty them a few times a day, typically for one to two weeks.
• Wearing a post-surgical bra. Soft, flexible bras with wide straps, front closures, and no underwire provide support and comfort during lumpectomy recovery. You doctor can help you find styles that work best for you.
• Limiting activity. You’ll likely need to avoid intense activity that could cause pain at the surgical site (lifting heavy objects, running, etc.) for one to two weeks post-surgery.
• Performing arm exercises. Gentle, simple movements such as backward shoulder rolls and arm circles may be recommended for restoring range of motion.
• Watching for signs of infection. You should contact your doctor immediately if you develop symptoms such as redness, pus, hot skin, pain that doesn’t go away with OTC pain relievers, or a bad smell from the incision.