Breast-conserving surgery (lumpectomy or partial mastectomy) for breast cancer

Surgery Overview

Breast-conserving surgery removes the cancer and surrounding tissue. The goal is to take just enough tissue so that the breast looks as normal as possible after the surgery but the chance of the cancer coming back is low.

The size and location of tumors differs from one person to another, so the amount of tissue removed during surgery also varies. To make it simple, you can think of two general breast-conserving surgeries: a lumpectomy and a partial mastectomy. Lumpectomy is the surgical removal of the breast lump and some of the tissue around it. The lump is removed in one piece and sent to the lab for examination.

Partial mastectomy is more extensive. It is the removal of the area of the breast that contains cancer, some of the breast tissue around the tumor, and the lining over the chest muscles below the tumor. Some of the lymph nodes under the arm are also taken out. A sentinel lymph node biopsy removes just a few lymph nodes to be examined under a microscope to check for cancer cells. If cancer is found in those lymph nodes, more lymph nodes will be removed. If the tests done before your surgery suggest that there is cancer in the lymph nodes near the breast, several lymph nodes will be taken out during your surgery. This is called an axillary lymph node dissection.

Most people who have breast-conserving surgery also have radiation therapy . You may also have chemotherapy , hormone therapy , or both.

What To Expect After Surgery

A lumpectomy can be done with local anesthesia if you are not having lymph nodes removed. If you are having lymph nodes removed or are having a partial mastectomy, you will have general anesthesia .

After your surgery, you will be taken to a recovery room. A nurse will be able to help with any nausea, pain, or anxiety you might have.

Many people go home the day of the surgery, but you may stay in the hospital for a day or two. Your doctor or nurse will give you instructions on pain control and caring for the surgical wound. In general, you can remove the bandage and take a shower on the day after surgery. You can wear a bra if it is comfortable. Some doctors recommend wearing a bra day and night for a few days for support.

Most people are able to get back to normal activity within a few days. But be sure to wait for your doctor to tell you when you can start with more strenuous physical activity. This will depend on the extent of the surgery and on other treatment you might be having.

If you are going to have radiation therapy, it will not start until the wound heals. This usually takes at least 2 weeks.

Why It Is Done

Breast-conserving surgery is done in early-stage breast cancer to remove as much cancer as possible and give the greatest chance of a cure.

How Well It Works

For stages I and II breast cancer, breast-conserving surgery with radiation therapy has the same survival rate as mastectomy and some of the same side effects. ¹

Risks

Complications of breast-conserving surgery are unusual but include infection, bleeding, poor wound healing, or a reaction to the anesthesia used in surgery. Blood or clear fluid may also collect in the wound and need to be drained. You may have feelings of pulling, pinching, tingling, or numbness.

There is also a risk that the cancer will come back, or recur. Some studies show that after breast-conserving surgery there is a 7% chance (1 in about every 13 people) that cancer will come back within 10 years, and a 20% chance (1 in every 5 people) that it will come back within 20 years. ²

What To Think About

The more breast tissue that is removed during this surgery, the more likely it is that there will be a noticeable change in the breast afterwards. Experts suggest that before having breast-conserving surgery, women talk with their doctors (and possibly a plastic surgeon) about what their breasts might look like after the surgery.

Breast-conserving surgery can be considered after the cancer has been staged. Breast-conserving surgery is not the best choice in many cases, such as if the cancer is bigger than about 2 in (5 cm) and is not shrinking from chemotherapy or if there are two or more tumors too far apart to be removed through one surgical opening (incision). ³

Breast-conserving surgery is usually followed by radiation. If you don't want to have radiation or if you cannot have radiation treatment, breast-conserving surgery is not usually a good choice.

Radiation therapy:

• Has to be done on a set schedule and takes several weeks. If you do not think you can go to every appointment, talk to your doctor about other treatment options.
• Is not recommended for people who have serious connective tissue diseases such as scleroderma.
• Should not be done on women who are pregnant. Radiation can harm the fetus . If radiation therapy can be safely delayed until after the baby is born, breast-conserving surgery may be possible for a pregnant woman.
• Should usually not be done where therapeutic radiation has been done before. If you have had previous radiation therapy to the same breast, your doctor will decide whether having more radiation after breast-conserving surgery would be too much for you.

Surgery is almost always recommended to treat breast cancer. If breast-conserving surgery is not a good option for you, then total or modified radical mastectomy , which removes the entire breast and sometimes the surrounding tissue, is a better treatment choice.

Complete the surgery information form (PDF) (What is a PDF document?) to help you prepare for this surgery.

References

Citations

1. National Comprehensive Cancer Network and the American Cancer Society (2005). Breast Cancer: Treatment Guidelines for Patients, version VII, pp. 1–81. Jenkintown, PA: National Comprehensive Cancer Network.
2. Morrow M, Harris J (2004). Local management of invasive cancer: Breast. In JR Harris et al., eds., Diseases of the Breast, 3rd ed., pp. 719–744. Philadelphia: Lippincott Williams and Wilkins.
3. American Cancer Society (2009). Detailed guide: Breast cancer: Surgery for breast cancer. Cancer Reference Information. Available online: http://www.cancer.org/docroot/CRI/content/CRI_2_4_4X_Surgery_5.asp?rnav=cri.

Other Works Consulted

• Weber ES, Sherk SD (2004). Lumpectomy. In AJ Senagore, ed., Gale Encyclopedia of Surgery: A Guide for Patients and Caregivers, vol. 2, pp. 910–913. Cleveland: Thomson Gale.