To see an animated version of this procedure, click Procedure InMotion .

Definition

Lumpectomy is the removal of part of the breast. Lumpectomy is almost always followed by an appropriate course of radiation therapy and, in some cases, chemotherapy .

Lumpectomy may be combined with a procedure to sample lymph nodes in the area (axillary dissection or sentinel node biopsy ) to determine whether the cancer has spread locally. This information will be useful in planning further treatment.

Parts of the Body Involved

A lumpectomy is performed on the breast.

Reasons for Procedure

To treat breast cancer .

Risk Factors for Complications During the Procedure

• Obesity
• Poor nutrition
• Smoking
• Recent or chronic illness
• Use of certain medications or dietary supplements
• Characteristics of the tumor to be removed—lumpectomy may not be appropriate for multiple masses or single masses that are:
  • Very close to the nipple
  • Very large
  • Attached to the chest wall or other nearby structures
  • Growing very rapidly
• Lumpectomy may not be appropriate for women who cannot undergo follow-up radiation treatments because of:
  • Pregnancy
  • Collagen-vascular disorders ( lupus , scleroderma )
  • Previous radiation therapy to the chest

What to Expect

Prior to Procedure

Your doctor will likely do the following:

• Physical exam
• Mammogram
• Fine needle biopsy of the breast
• Blood and urine tests
• Wire-localization procedure—if the tumor was visible on mammogram, but is not able to be felt

In the days leading up to your procedure:

• Discuss any medications or dietary supplements you are taking with your surgeon.
• Do not eat or drink anything for 8 to 12 hours before surgery, unless your surgeon tells you otherwise.

During Procedure

IV fluids and anesthesia will be administered and a tube is inserted down the throat so that a ventilator can assist with breathing (intubation).

Anesthesia

General anesthesia is most often used.

Description of the Procedure

A small incision is made in the breast and the tumor is cut out, along with some of the surrounding tissue. Another incision, near the armpit, may be made so that lymph nodes can be removed. The nipple and areola are not removed, as they are with mastectomy. Plastic tubes for drainage may be inserted and are usually removed in the surgeon's office 1 to 2 days later. The incisions are closed with stitches, which are removed about a week after surgery.

	Lumpectomy
	© 2008 Nucleus Medical Art, Inc.

After Procedure

Removed tissue is examined by a pathologist to determine if any further surgery is necessary.

How Long Will It Take?

The procedure typically takes 1 to 3 hours.

Will It Hurt?

Anesthesia prevents pain during the procedure. There is usually relatively little pain after a lumpectomy, but there may be temporary unpleasant sensations, including numbness and a pinching or pulling feeling in the underarm area. Patients who have lymph node biopsies generally experience more discomfort, in part because the area operated on, and in part because motion of the arm tends to pull on the axilla, where the node biopsies are taken. You may be prescribed pain medication or antibiotics.

Possible Complications

• Hematoma (accumulation of blood in the wound)
• Seroma (accumulation of clear fluid in the wound)
• Infection
• Numbness of the nipple or underarm skin
• Swelling of the arm caused by accumulation of fluid in lymph nodes (lymphedema)
• Change in the size and/or shape of the breast
• Phlebitis (an inflammation of the veins)

Average Hospital Stay

Lumpectomy is generally done on an outpatient basis and typically does not require a hospital stay. If lymph node biopsy is done at the same time, a hospital stay of a day or two is usually required.

Postoperative Care

• Keep the surgical area clean and dry.
• You will have a bandage over the surgical site and may have one or more tubes to drain blood and fluids that collect during the healing process. You must empty the drains, measure the fluid, and report any problems that your doctor may tell you to watch out for.
• Avoid vigorous activity for about four weeks, or as directed by your doctor.
• Try not to lift anything heavier than five pounds for about a week, or longer if directed by your doctor.
• Wear a well-fitting, very supportive bra 24 hours a day for the first week.

If you've had lymph nodes removed, your arm is at risk of fluid accumulation and swelling (lymphedema) and/or serious infection (lymphangitis). These complications are more common in patients who have had an axillary dissection than in those who have had sentinel node biopsy, many of whom experience no side effects after the area has healed. If you do develop complications from lymph node surgery, you'll need to take some special precautions:

• Don't have blood pressure taken, blood drawn, or shots given in that arm.
• Wear gloves to do dishes, household scrubbing, and yard work.
• Don't wear anything tight on that arm, including elastic in sleeves.
• Don't carry heavy packages, purses, suitcases, grocery bags, etc. with that arm.
• Keep the skin of that arm well-moisturized with a lanolin-containing product.
• Use an electric shaver if you wish to shave your armpits.
• Do not get a sunburn.

Outcome

The breast may change in size or shape after lumpectomy, and redness and swelling may occur with radiation therapy. There may be local skin discoloration from dye used to localize lymph nodes for biopsy, and the dye may also discolor the urine for a short time after surgery. The redness and swelling that occur with radiation treatment are temporary, but the breast may also develop a firmness as a result of treatment that is noticeable to the patient, although it is not usually severe.

You'll see your doctor for a follow-up appointment within 7 to 14 days after the surgery.

Call Your Doctor If Any of the Following Occurs

• Signs of infection, including fever and chills
• Redness, swelling, increasing pain, excessive bleeding, or discharge from the incision site
• Cough, shortness of breath, chest pain, or severe nausea or vomiting
• Redness, warmth, swelling, stiffness, or hardness in the arm or hand on the side of the body where the lymph nodes were removed
• New, unexplained symptoms
• A lump or redness, swelling, or inflammation of the tissue of either breast
• Drainage from either nipple

RESOURCES:

American Cancer Society
www.cancer.org

Breastcancer.org
http://www.breastcancer.org

CANADIAN RESOURCES:

Canadian Breast Cancer Foundation
http://www.cbcf.org/

Women's Web
http://www.womensweb.ca/

References:

American Cancer Society website. Available at: http://www.cancer.org .

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