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Lumpectomy: 7 things to know

BY KELLIE BRAMLET BLACKBURN

https://www.mdanderson.org/cancerwise/lumpectomy-for-breast-cancer-treatment--what-it-is--what-to-expect-and-recovery.h00-159460845.html

 

A lumpectomy is the most common type of surgery used in breast cancer treatment. At MD Anderson, our breast cancer surgeons perform around 900 lumpectomies each year. 

So what is a lumpectomy, and what should breast cancer patients expect from the procedure and the recovery? And how does it compare to a mastectomy? 

We spoke with breast surgeon Puneet Singh, M.D., about the benefits of a lumpectomy and what patients can expect.

What is a lumpectomy? 

A lumpectomy is a type of breast cancer surgery in which the tumor and a small amount of surrounding tissue called the margin is removed. The purpose of a lumpectomy is to remove the cancerous cells. 

It is also commonly referred to as breast conservation surgery because it leaves most of the breast intact compared to a mastectomy. 

On its own, a lumpectomy does not indicate if cancer has spread, but it may be performed along with a sentinel lymph node biopsy. This is a procedure in which surgeons remove nearby lymph nodes to determine if the cancer has spread. 

A lumpectomy may also be performed with breast reconstruction, or reconstruction can be done at another time, depending on the patient’s diagnosis and wishes. 

Who should get a lumpectomy? 

A lumpectomy is often the treatment of choice for patients with early stage breast cancer, but it can be a great surgical option for many types of breast cancer. 

“We typically recommend it for patients who have smaller, early-stage cancer, and we consider the size of the tumor compared to the overall size of the breast,” Singh says. 

Typically, a lumpectomy is followed by four to six weeks of radiation therapy  to ensure that there are no more remaining cancer cells, so lumpectomies are not recommended to patients who can’t withstand radiation. Some patients who have chemotherapy first may consider it as well. 

What are the advantages and disadvantages of a lumpectomy? 

Landmark studies dating back to the 1970s and 80s show that patients who have a lumpectomy and radiation therapy have the same low risk for recurrence as patients who have a full mastectomy, or removal of the entire breast. 

“Patients need to pick what’s right for them, but a lumpectomy provides the same very low rate of recurrence as with a mastectomy, but with a shorter and easier recovery,” Singh says. 

When paired with the right surveillance after treatment, a lumpectomy may also be an option for breast cancer patients who carry genetic mutations like BRCA1 and BRCA2 that put them at a greater risk for cancer. 

“BRCA-positive patients may assume that a mastectomy is the only treatment option for them, but that’s not always the case,” Singh says. 

A lumpectomy allows patients to conserve more of the breast. This may make it a more cosmetically appealing option. It also allows most patients to preserve the nipple and the surrounding area, and maintain more sensation or feeling than they might with a mastectomy. 

“Some patients say it didn’t even feel like they’ve had surgery following a lumpectomy,” Singh says.  

What should patients preparing for a lumpectomy expect? 

Typically, a lumpectomy is a short, outpatient procedure. Most patients receive general anesthesia, but care teams may also use an IV with a sedative, or relaxing medication, and a local anesthetic is used to numb the area being operated on. 

The procedure typically takes about 15 to 40 minutes. “But at MD Anderson it may take a little longer because we have such a thorough review process during the surgery,” Singh says. 

At MD Anderson, after a surgeon removes the tissue, it’s reviewed by a pathologist who uses imaging to review the entire specimen as a whole and then reviews it again, section by section. Finally, in a multidisciplinary discussion, the pathologist, radiologist and surgeon will review the images together and decide if more tissue needs to be removed. 

In 2018, MD Anderson surgeons published a study that demonstrated that this detailed intraoperative review of the tissue resulted in a much higher clear margin rate. This means that more patients were cancer-free after their lumpectomies. 

The surgery may take longer if the patient also decides to have breast reconstruction at the same time as the lumpectomy and depending on the type of reconstruction the patient chooses. MD Anderson plastic surgeons work with patients to determine if reconstruction is right for them, and if so, which procedure best suits their needs. Lumpectomy patients often choose one of the following types of reconstruction: local tissue rearrangement, breast lift and/or reduction or latissimus dorsi or similar flap. 

What is lumpectomy recovery like? 

Shortly after lumpectomy is complete, the patient will be able to go home. Thanks to our Enhanced Recovery Program, most MD Anderson patients recovery quickly with little pain. 

“Some don’t even need pain medication or can take over the counter drugs, like ibuprofen,” Singh says. 

Recovery may be longer if a patient has breast reconstruction at the time of the lumpectomy.  
Will patients need a second surgery after a lumpectomy? 

After the lumpectomy, the removed tissue is studied by a pathologist. If they find cancer cells in the normal tissue surrounding the tumor, they may perform a second surgery. “But thanks to our thorough review process, most MD Anderson patients don’t need a second surgery,” Singh says. 

Patients who choose reconstruction may have an additional surgeries depending on what type of reconstruction they choose. 

How will a lumpectomy change a patient’s appearance? 

“A lumpectomy’s cosmetic impact really varies greatly from patient to patient and depends on the size of the tumor compared to the size of the breast and how much of the breast is being removed,” Singh says. 

At MD Anderson, breast surgeons work closely with plastic surgeons to perform reconstruction that meets the patients’ needs and wishes.  

“Make sure to have a thorough conversation with your surgical team ahead of time to discuss your options for breast reconstruction and choose what’s best for you,” Singh advises patients preparing for a lumpectomy. “With a skilled team that listens to their patient’s goals, a lumpectomy can be a simple, curative option for many early-stage breast cancer patients.”

Last updated June 4, 2021