Lumpectomy is a surgical method for breast lump removal i.e. cancerous tissue or tumor from the breast. This is also called as breast-conserving or breast preserving surgery as unlike mastectomy it removes only some part of breast. This surgery is helpful when lump is detected at early stage.
A lumpectomy is a conservative form of surgery performed to remove a lump or a cancerous tumor along with the surrounding tissues of the breast. Some surrounding tissues are also removed to ensure that all the cancerous and abnormal tissues are entirely removed.
Lumpectomy is followed by radiation or chemotherapy to ensure that all cancer cells have been destroyed.
This surgery aims to make the breast look as normal as possible while keeping the risk of cancer recurrence at a minimum.
The location and the size of the breast tumor are different in patients; hence the amount of tissue that needs to be surgically excised also differs.
There are generally two main types of breast cancer surgery. One is Lumpectomy (breast conserving surgery), and the other is Mastectomy.
Lumpectomy: In this surgery, only a part of the breast is removed. tumor or the abnormal tissue along with the surrounding breast tissues with a lining of the chest muscles lying below the lump or tumor is removed.
How much tissue is to be removed depends on the size and location of tumor. Depending on the amount of tissue removed, lumpectomy is also named as quadrantectomy, partial mastectomy and segmental mastectomy. For e.g. in quadrantectomy, approximately a quarter of breast is removed.
Mastectomy: In this surgery, the entire breast is removed, i.e. all the breast tissues and sometimes nearby tissues are also removed. This is performed in cases where large mass is to be removed, or many tumors are present.
A lumpectomy may be performed for diagnostic or therapeutic reasons:
Diagnostic reasons for performing a lumpectomy include:
A suspicious breast lump is seen on a radiological examination and confirmed on fine-needle cytology studies.
Fine needle cytology study is a simple method of biopsy in which a fine needle is passed through the skin to take the sample cyst or tissue or fluid and is sent to the pathology lab for examination.
A lump that is located under the pectoral muscles in such a way that it makes radiological diagnosis difficult.
Therapeutic indications include:
Breast lumps like fibroadenoma which is benign in nature
A lumpectomy is never recommended if prior fine needle aspiration cytology studies have not confirmed the exact nature of the breast mass.
Lumpectomy is generally not recommended if the patient has any of these conditions:
- Have multiple tumors
- Have huge tumors and cancer is spread to the lymph nodes and tissues around the breast.
- Have had a previous breast cancer treatment.
- The site of tumor is such that it is hard to remove sufficient surrounding tissues.
- Have a larger tumor and small breast.
- Before the process of lumpectomy, doctor describes the process, risks, precautions thoroughly and expected results of the surgery.
- Physical examination and imaging with mammography are performed to examine the size and shape of tumor.
- In the appointments with the doctor before surgery, your doctor will ask for some details like, your allergies, medications, pregnancy etc.
- Blood thinning medications should be avoided from weeks before surgery. It might increase the risk of excess bleeding.
- Patient must be fasting and avoid liquids from 8 to 12 hours before surgery.
Here’s the Step By Step Procedure of Lumpectomy Surgery-
Step 1: Mammogram And Biopsy
Mammogram and biopsy are performed before the lumpectomy. If breast abnormality is detected, during biopsy radiologist will place a clip or a marker in breast. This is done to quickly locate the lump or mass to be removed during surgery.
Step 2: Anesthesia
To begin the surgery, general or local anesthesia is given to the patient. This surgery is usually performed under general anesthesia but the type of anesthesia used is decided on the basis of expected extremity of the surgery.
Local anesthesia is given along with sedative so that the patient remains relaxed during the surgery. This numbs the breast and nearby tissues. The patient will remain awake but will not feel any pain during the surgery. The patient does not need to stay in the hospital and can leave hospital on the same day of surgery.
General anesthesia causes unconsciousness, the patient remains in sleep and will not feel any pain during surgery. In this case, patient will need to stay in the hospital overnight.
Step 3: Locating The Area To Be Removed
After giving the anesthesia, the area to be removed is located. This is done by inserting a wire to the clip or a radioactive marker. This wire guides the surgeon to the area which is to be removed.
If the lump can be easily felt through the skin, then wire procedure is not required, and the surgeon can easily find the area to be removed.
Step 4: Removing Lump/ Tumor And Surrounding Tissue
To remove the lump or mass doctor makes an incision over the tumor or the area that contain wire. Through this incision, surgeon removes the tumor and surrounding tissue and send it to the pathology lab for the test.
Sometimes, cancer spread to the lymph nodes. If lymph nodes are involved, they are also surgically removed with a separate incision. The doctor uses any of the two procedures for this, either sentinel lymph node biopsy or axillary node dissection.
Sentinel Lymph Node Biopsy: In this procedure, the surgeon removes the sentinel nodes, i.e. first one or two nodes. These nodes are then tested in lab for cancer.
This is performed when there were no signs of cancer or lymphedema, i.e. swelling or enlargement of lymph nodes before the surgery.
If the removed nodes tested negative for cancer, no further removal of lymph nodes is required. If it is tested positive than more lymph nodes are removed, or radiation therapy is done to treat the affected lymph nodes.
Axillary Node Dissection: In this procedure, surgeon removes a number of lymph nodes from the armpit of the side of tumor. This is performed when a lymph node biopsy has shown the sign of cancer.
Step 5: Closing Of Incision
After removing the lump, the incision is closed while keeping the appearance of breasts as normal as possible. The incision is closed with either dissolvable stitches or non-dissolvable which are removed by doctor later on.
Step 6: Radiation Therapy
Radiation therapy is a follow-up treatment after lumpectomy for every woman. This is done to destroy any cancer cell which might have been missed in lumpectomy.
Radiation therapy is started as soon as possible after lumpectomy. Radiation therapy is initiated after some healing of the wound. The healing time of lumpectomy is Approximately 30 days. It is usually scheduled for 6 weeks.
After the surgery, the operated area is covered with bandages, and the patient is transferred to the recovery room where, blood pressure, breathing and pulse rate will be monitored.
In the case of lumpectomy and sentinel node biopsy, patient is allowed to leave the hospital as soon as the condition is stable. But in case of axillary node dissection patient need to stay in hospital for one or two days.
If lymph nodes are removed in the surgery, drainage pipe is placed in the underarm to remove excess fluid. This pipe is removed after surgery when the fluid drainage is minimum.
Pain and numbness will be present in the treated area. To deal with it pain medications and antibiotics are prescribed.
Patient is properly instructed about the post surgery care, care of incision, dressings and recognising signs of infection.
After lumpectomy tissue samples taken during surgery are tested in pathology lab for cancer cells. If no cancer cells are found in the surrounding tissues of lump, that indicates that the woman has clear margins and do not require other surgery or treatment.
If tissue sample found positive for cancer, doctors discuss some other treatments with the patient like chemotherapy and other possible surgeries or treatment.
The risks and complications of lumpectomy include:
Risks Due To Anesthesia: General anesthesia put the patient at risk of breathing and heart problems.
Lymphedema: Sometimes after lumpectomy it may be hard for lymph fluid to drain. This may cause fluid retention which leads to swelling in arms.
Infection: There are risks of infection in the wound of incision. Antibiotics should be given following the surgery.
Problem With Wound Healing: Hematoma and seroma, i.e. accumulation of blood and fluid in the wound can delay or cause problem in the healing process of the wound.
Loss Of Sensation: After lumpectomy breast may be numb and there might be loss of sensation. This happens when nerve is affected during the surgery. This also depends on the size of lump removed.
Asymmetrical Breasts: Breasts may not match in size and shape as the affected breast from which tissue is removed will look smaller. This will not be noticeable immediately after surgery as there will be swelling in the operated area after surgery.
Side Effects Of Radiation Treatment: Side effects of radiation include skin changes like redness and burning of the skin.