Lumpectomy

What is a lumpectomy?

A lumpectomy, also known as partial mastectomy or segmentectomy, is breast cancer surgery that removes a tumor in your breast while leaving your breast intact. Lumpectomies can be diagnostic — a procedure that tests whether a tumor is malignant (cancer) or benign (not cancer). More often, a lumpectomy is cancer treatment. The goal is to eliminate all cancer cells by removing the tumor instead of removing your breast entirely, as with a mastectomy.

For this reason, a lumpectomy is often called breast-conserving surgery.

Most people who get a lumpectomy to treat cancer also get radiation therapy afterward. Radiation reduces the likelihood that the cancer will return (recur).

Types of lumpectomy procedures

Types of lumpectomy procedures include:

• Excisional biopsy. This procedure is diagnostic. A surgeon removes the tumor as part of a biopsy. A pathologist tests the tissue in a lab to see if the tumor is cancerous or benign.
• Wide local excision. This surgery treats cancer by removing the tumor plus a small margin of nearby healthy tissue. A pathologist will test the margin to ensure there’s no sign of cancer cells. No cancer cells in the margins means the surgery successfully removed the cancer.
• Quadrantectomy: This surgery removes about a quarter of your breast, including the tumor, a margin of healthy tissue and the area containing your milk ducts.
• Re-excision of margins: This surgery is a follow-up procedure to a wide local excision. If your test results show signs of cancer cells in the margin of healthy tissue, your surgeon will need to reopen the surgical site and remove more tissue to ensure all cancer cells are gone.

Who needs a lumpectomy?

Your healthcare provider may recommend a lumpectomy if it’ll get rid of the cancer (with little risk of recurrence) while preserving your breast’s appearance. You may be a candidate for a lumpectomy if:

• Cancer only affects one area of your breast.
• The tumor is relatively small compared to your breast volume.
• You’ll likely have enough remaining tissue to reshape your breast after the tumor’s gone.
• Your health (and schedule) will allow you to complete radiation therapy afterward.

Who shouldn’t have a lumpectomy?

Your provider may advise against getting a lumpectomy if you have:

• Multiple tumors in one breast.
• A tumor that’s large compared to your breast volume.
• Cancer that’s penetrated your breast skin or your chest wall.
• A type of breast cancer that’s considered fast-growing (like inflammatory breast cancer).
• A family history of breast cancer or DNA (like BRCA gene mutations) that makes you high-risk for having recurrent cancer.
• Breast cancer that’s recurred after a previous lumpectomy with radiation.

A lumpectomy may not be the best option if radiation therapy poses risks. You may not be a candidate if:

• You’ve had previous radiation to the same breast (and having more would expose you to harmful amounts of radiation).
• You have a skin condition that increases your risk of complications following radiation therapy (like scleroderma and Sjögren’s syndrome).
• You’re pregnant (unless your timeline allows you to have the lumpectomy during the third trimester and radiation after your baby’s born).

How should I prepare for a lumpectomy?

To plan:

• Make sure you understand your treatment options. Be sure you understand why breast-conserving surgery is the best option for you. Make sure you understand what to expect afterward (like whether you’ll need radiation or reconstructive surgery to shape your breast).
• Make sure you understand instructions about medicine and fasting. Follow your provider’s instructions about what medicine, herbs, vitamins and supplements are safe to take and which ones to avoid. Know when you should stop eating or drinking before surgery.
• Arrange for a driver. You’ll likely feel groggy from anesthesia once the procedure’s finished. Have someone you trust drive you home.

What happens during a lumpectomy?

On the day of your surgery:

1. A healthcare provider called a radiologist will perform imaging (usually an ultrasound or mammogram) to locate the tumor inside your breast. They’ll insert a small chip or wire to mark the spot for the surgeon.
2. You’ll receive medication to prevent you from feeling pain. Most people receive general anesthesia that puts them to sleep. Or, you may need moderate sedation and local anesthesia that just numbs the tumor site.
3. The surgeon will refer to these markers to remove the tumor and a thin border of surrounding healthy breast tissue.
4. The surgeon will inject medicine to reduce any pain you may feel after surgery. They’ll place small marker clips into the area where the tumor was. This marker helps the radiation oncologist know where to direct the radiation when you return for radiation therapy.
5. The surgeon will use sutures to sew your skin back together. Usually, they’re dissolvable, which means you won’t need to return to have them removed.

Lymph node removal

During your lumpectomy, your care team will likely remove a few lymph nodes from the armpit closest to your tumor. They’ll send them to a lab to test for cancer cells. This is called a sentinel node biopsy (SNB). Cancer cells (and all other cells) drain into your lymph nodes. If the lymph nodes contain cancer cells, that means your cancer’s spread beyond the tumor.

You’ll likely need additional treatments and tests if the cancer spreads to your lymph nodes.

Reconstructive surgery

Your care team may include a reconstructive surgeon, who shapes and repairs your breast immediately after your lumpectomy. Some people wait until the breast tissue has had time to heal (and the breast shape has settled) before reconstructive surgery.

Ask your healthcare provider about your options for reconstructive surgery. If the lump is small, you may not need this procedure. If you do, it’s important to understand how this surgery will impact your care and recovery time.

How many hours is lumpectomy surgery?

Lumpectomy and SNB surgery is usually outpatient, meaning you can go home that same day. Locating the tumor and removing it usually takes between one to two hours. It may take longer if you’re having reconstructive surgery alongside a lumpectomy.

You’ll likely be released the same day, as soon as your vitals (pulse, blood pressure and breathing rate) are stabilized enough.

What happens after a lumpectomy?

After a lumpectomy, a pathologist will test the cells in the tumor and in your lymph nodes for cancer. These results will determine the next steps. The best-case scenario involves finding no cancer in the lymph nodes and a “negative margin” in the tumor. This means that there are no (negative) cancer cells in the healthy tissue.

• If results reveal signs of cancer in your lymph nodes, you may need additional tests or treatments.
• If results show a “positive” margin in your tumor, you may need additional surgery to remove all the cancer cells.
• If results show unique cancer cell characteristics, you may need to start specific treatments. For example, if the cancer cells contain hormone receptors, hormones in your body (like estrogen) may fuel their growth. You may need hormone therapy to combat this.

Your healthcare provider can advise you on the next steps based on your results.

Radiation therapy

Most people need three to six weeks of daily radiation therapy after a lumpectomy. But the specific timeline varies based on your diagnosis. Ask your provider what your treatment schedule will look like.

In some cases, you may not need radiation. For example, if you have a type of breast cancer with a very low risk of recurrence, like ductal carcinoma in situ, you may not need radiation therapy. Your provider will recommend treatments based on your unique diagnosis.

What are the benefits of a lumpectomy?

The most obvious benefit of a lumpectomy is that you can get rid of the cancer while keeping your breasts. You get to keep the way they look. You get to keep the sensations your breasts allow you to feel.

Lumpectomy used to be the gold standard treatment for early-stage breast cancers only. For this reason, many people think of lumpectomy as the less aggressive treatment option when compared to a mastectomy. The thinking goes: For less serious breast cancers, you can remove the tumor but keep your breast.

But it’s not that straightforward. Research has shown that in many cases (not just early-stage cancer), a lumpectomy with radiation has the same survival outcomes as a mastectomy. It has the same recurrence rate. Increasingly, lumpectomy with radiation has become the recommended first treatment for various types of breast cancer.

The procedure that provides the best benefit depends on numerous factors — like your cancer type, stage and grade (how atypical the cells are) — that your provider can explain to you.

What are the risks or complications of a lumpectomy?

Lumpectomy is a common surgery that’s considered safe and effective. Still, every surgery comes with some risks. Potential complications include:

• Infection near the incision site.
• Collection of clear fluid (seroma).
• Collection of blood (hematoma).
• Scarring from the radiation (radiation fibrosis).
• Bruising and swelling in your arm or hand closest to your breast (lymphedema).
• Shooting pain in your arm, armpit or chest (usually goes away within a few weeks).

Your breast’s appearance may change as the tissue heals. You may need to work with a cosmetic surgeon if you’re not pleased with the way your breast looks after surgery.

How long is recovery from a lumpectomy?

Most people feel fully recovered two weeks after surgery. You may feel extra tired immediately after surgery and have pain, swelling and bruising. Your provider may send you home with an ice pack to place in your bra to keep swelling down. Typically, symptoms gradually improve each day.

Still, everyone heals at their own pace. Ask your healthcare provider about recommendations for managing pain or discomfort.

What should I avoid doing during recovery?

Follow your healthcare provider’s instructions on the do’s and don’ts of recovery. For example, they may advise you not to lift anything heavy or to avoid exercise after a certain period. They may advise you to shower instead of taking a bath.

Take care to follow instructions closely.

When should I call my healthcare provider?

Let your provider know if you see any signs of an infection, which can pose serious health risks. Call if you notice any of these symptoms in or near the affected breast:

• Redness and swelling.
• Skin that’s warm to the touch.
• Purulent (thick and milky) drainage.
• Fevers, sweats, chills.
• Fluid that builds up in or around your breast.
• Pain that gets worse after surgery.

A note from Cleveland Clinic

A lumpectomy removes breast cancer while preserving the look and feel of your breasts. This can make you feel more like yourself after breast surgery. While many people think of mastectomies as the more aggressive and foolproof breast cancer treatment, lumpectomy with radiation has comparable survival and recurrence outcomes for many types of breast cancer.

Ultimately, your breast cancer treatment should be highly personalized to your needs. Discuss the pros and cons of treatment options (including a lumpectomy vs. a mastectomy) with your healthcare provider.