Definition and Overview

A lumpectomy is a surgical procedure used in the diagnosis and treatment of abnormal growths on the breast. When done for diagnostic purposes, it allows the doctor to take a sample of the breast tissue to test for malignancy. When used as part of a treatment, the procedure removes the malignant tumour or lump to keep it from growing and affecting surrounding tissues.

A lumpectomy, which removes only a part of the breasts, is also known as partial mastectomy or a breast conservation therapy because unlike a total mastectomy, there is no need to remove the breast tissue, muscles, and lymph nodes. The procedure was specially designed to effectively remove only the tumour and the tissue surrounding it without affecting the natural appearance of the breast. As a result, the breast is left mostly intact.

Who Should Undergo and Expected Results

A lumpectomy is beneficial for those who are diagnosed with an abnormal growth, lump, or tumour on the breast. Due to the conservative and less invasive nature of the procedure that allows a woman to retain the normal appearance of her breasts, it is now widely preferred over the more radical alternative, which is a mastectomy.

However, this breast conservation therapy has certain limitations. It is not recommended for the following cases:

  • When the tumour is larger than 5mm in diameter
  • When the patient’s breast is small and is therefore easily disfigured even by small to medium-sized tumors
  • When the tumor is growing at a rapid rate
  • When the tumor has spread over a large part of the breast
  • When the tumor has affected the chest wall
  • When there are multiple tumors affecting different parts of the breast
  • Recurrent breast cancers
  • Cancer that has spread to other locations
  • When the patient has had previous rounds of radiation in the chest area for the treatment of other conditions
  • When the patient has a condition, such as pregnancy or collagen vascular disease, that makes it dangerous for her to undergo the radiation therapy that follows a lumpectomy.
    This means that this procedure is the preferred choice only if the tumour is detected early and is therefore still small in size. If the tumor is too big, doctors may try to shrink it first using chemotherapy or endocrine therapy. If the initial treatment works, then a lumpectomy may be possible.

Moreover, a person diagnosed with breast cancer still has to undergo other cancer therapies after a lumpectomy. Studies show that the combination of a lumpectomy and radiation treatment has proven highly effective in treating the disease. Thus, prior to undergoing the surgery, the patient will be asked to commit to completing a series of radiation therapy sessions.

How Does the Procedure Work

If a woman is suspected of having an abnormal lump on the breast, she is first given a mammogram, or an x-ray that takes images of soft tissues that make up the breast. Other types of diagnostic procedures may also be performed, such as a wire localisation procedure or breast MRI scan.

Once a lumpectomy is found to be potentially beneficial for a patient, the surgeon will begin preparing the patient for the procedure. This preparation process plays a key role in ensuring the patient’s safety, reducing the risk of complications, and increasing the likelihood of a successful surgery. As part of this process, the surgeon will ask the patient about any medications and supplements she may be taking, as some of these may have an effect on the patient’s condition during and after the lumpectomy.

Patients are also given pre-surgical instructions before undergoing surgery. For example, they are advised not to eat anything 8 to 12 hours prior to the procedure. They are also informed beforehand about what to expect from the surgery and how to tell if something is normal or not.

There are different types of breast conservation therapies that can be performed depending on the size and position of the lump. These include the following:

  • Wedge resection
  • Wide excision biopsy
  • Sentinel node biopsy
  • Axillary lymph node sampling or dissection
  • Quadantectomy, in which only a quarter of the breast is removed

The specific technique to be used is discussed by the surgeon and the rest of the patient’s medical team before the procedure is performed as part of the treatment planning process.

A lumpectomy is performed under general anaesthesia. Thus, the patient should also consult with her anaesthesiologist prior to the procedure to determine what kind of anesthetics will be used, what possible side effects can be expected, and how to prevent adverse reactions.

During the procedure itself, which takes around 2 to 3 hours, the surgeon first cleans the affected breast as well as the surrounding area of the chest and upper arm. The surgeon then marks the location of the tumour and makes an incision to access the affected tissues. If the entire tumor has to be removed, the surgeon cuts it out along with a margin of healthy tissue surrounding it. If only a biopsy sample is needed, the surgeon injects a needle into the lump and extracts a piece of tissue from it.

If axillary lymph nodes also need to be removed to effectively remove the tumour and prevent recurrences, the surgeon also makes an incision near the underarm to gain access to said nodes.

When the affected tissues are removed, the doctor closes the incision using dissolvable stitches and the entire chest area is wrapped with a bandage.

It is normal for patients to be sent home after a few days in the hospital, usually with a drain still attached to their breasts. This helps remove the excess fluid from the breast and is removed after a few days.

Possible Risks and Complications

It is normal to feel some pain immediately after the procedure, which may last for up to three days. For short-term pain and soreness, placing ice bags over the bandaged area or taking prescription pain medications may help relieve the pain. However, patients are advised to seek the advice of their doctor regarding the appropriate type of pain medication to use.

A lumpectomy is also associated with some possible complications, such as:

  • Long-term pain – If the pain following the surgery seems to increase or does not seem to improve, patients are advised to consult their doctor.
  • Numbness
  • Limited shoulder movements
  • Lymphedema
  • Increased risk of infections
  • Bleeding
  • Blood clots
  • Delayed healing – The recovery period depends on the size of the tumour. The bigger the tumor, the longer it will take for the patient to heal.

To prevent complications and to facilitate faster healing, patients are advised to refrain from strenuous physical activities for the first several days and to wear a comfortable well-fitting bra for a week after a breast conservation therapy. Patients are also informed about what symptoms to watch out for.

To ensure the success of a lumpectomy and to proceed with the rest of the treatment for cancer, the patient will also be given a schedule of follow-up appointments. The first follow-up visit is usually scheduled 10-14 days after the procedure and allows the doctor to check on the results of the surgery, to monitor the patient’s condition, and recovery progress, and to discuss the next steps that need to be taken.

References:

  • Cuzick J, DeCensi A, Arun B, Brown PH, Castiglione M, Dunn B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011. 12:496-503. PMID: 21441069 www.ncbi.nlm.nih.gov/pubmed/21441069.

  • Heisey RE, McCready DR. Office management of a palpable breast lump with aspiration. CMAJ. 2010;182:693-6. PMID: 20194561 www.ncbi.nlm.nih.gov/pubmed/20194561.

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