A lumpectomy is a surgical procedure performed to remove malignant or other abnormal breast tissue. Since during a lumpectomy the surgeon removes the smallest amount of breast tissue possible, the procedure is sometimes referred to as breast-conserving or breast-sparing surgery.
Reasons for a Lumpectomy
There are two primary reasons a lumpectomy has to be performed. These involve either a malignancy or a benign growth in the breast tissue.
Most frequently, a lumpectomy is performed after a breast mass has been found during physical examination or through a mammogram and has been confirmed, by ultrasound and a core needle biopsy, to be malignant. Candidates for lumpectomies are patients in whom the cancer is considered to be low grade and not likely to have spread to adjoining tissues, although this cannot be definitively determined until the lumpectomy and subsequent pathology report are completed.
When there is suspicion that the cancer may have spread, a sentinel lymph node biopsy will also be done, during which the node, or a part of the node, closest to the breast tumor will be removed for analysis. If the cancer is found to have spread to the sentinel node, other nodes may be removed to see how far the malignancy has traveled. In a sentinel node biopsy, a tracer or contrast dye is injected into the node in order to locate it more exactly. If the breast cancer has already spread or is of a particularly agressive variety, a mastectomy may be necessary.
Although often performed to remove cancerous breast tissue, a lumpectomy may also performed to excise benign tumors of the breast, such as fibroadenomas. Fibroadenomas are most commonly found in women under 30 years of age, often adolescents, and are composed of fibrous or glandular tissue. The cause of fibroadenomas is not known, although they develop more frequently, and at a younger age, in African-American women than in Caucasian women.
The Procedure of Lumpectomy
The procedure of a lumpectomy, although often anxiety-producing to patients, is a simple one. Prior to the surgery, the site of the tumor is marked on the patient's breast with an indelible marker and often a metallic marker is implanted in the precise location of the tumor as well. These measures guide the surgeon and assure precision during the operation. The lumpectomy may be performed under general or local anesthesia, depending on individual circumstances, and sometimes a drainage tube will be temporarily implanted under the patient's arm to drain excess fluid. A lumpectomy usually takes between 15 minutes and an hour to complete and the patient is able to return home the same day.
Recovery from Lumpectomy
After a lumpectomy, the patient returns home after the surgery and can resume normal activities in as few as 5 days. The following measures are commonly taken to assist in healing:
- Ice packs on the affected area
- Rest and avoidance of strenuous activity, especially involving the upper body
- Over-the-counter painkillers for pain and discomfort
- Caring for incisions according to doctor's instructions
- Being aware of signs of infection, such as swelling or fever
- Follow-up appointment with the physician
As noted, there is always a chance when a patient has a lumpectomy that the cancer has not been entirely removed. A pathology report is done on the tissue removed, which includes tissue from the tumor itself and a small amount of surrounding tissue. The surgeon's goal is to obtain clean margins around the tumor. If the pathology report shows that the margins are not clear, a second lumpectomy must be performed. This is not at all uncommon since the surgeon removes as little breast tissue as possible during the lumpectomy in an attempt not to disfigure the breast. Radiation may be deemed appropriate as a precaution, particularly if this episode of breast cancer represents a reocurrence. If the cancer has spread to the sentinal node, a mastectomy and or chemotherapy will usually be necessary to avoid further spread of malignancy.
Risks of Lumpectomy
There are few risks associated with the simple procedure of a lumpectomy, but, as with any type of surgical procedure, the patient should be aware of possible complications, such as:
- Infection, signaled by redness or swelling at the site, or fever
- Edema of the arm in the case of lymph node removal
- Excessive bleeding
- Allergic reaction to anesthesia or dye