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Breast lump removal

Definition

Breast lump removal, called lumpectomy, is surgery to remove a breast cancer or other lump in the breast, along with some surrounding tissue from the breast.

This article covers lumpectomy that is done to remove breast cancer. Other reasons to perform a lumpectomy include:

• Fibroadenoma
• Other noncancerous tumors of the breast

See also:

• Breast biopsy - open
• Breast biopsy - stereotactic
• Breast biopsy - ultrasound (core needle)
• Mastectomy

Alternative Names

Lumpectomy; Wide local excision; Breast conservation surgery; Breast sparing surgery; Partial mastectomy

Description

If the breast cancer can be seen on a mammogram or ultrasound but the doctor cannot feel the cancer on a physical exam, a wire localization will be done before the surgery:

• A radiologist will use a mammogram or ultrasound to place a needle (or needles) in or near the abnormal breast area.
• This will help the surgeon know where the cancer is so that it can be removed.

Breast lump removal is usually done in an outpatient clinic. You will be given general anesthesia (you will be asleep, but pain free) or local anesthesia (awake, but sedated and pain free). The procedure takes about 1 hour.

The surgeon makes a small cut on your breast. The surgeon then removes the cancer with some breast tissue around it.

• The goal is to remove breast cancer, along with a rim of normal breast tissue around it. When no cancer cells are near the edges of the tissue removed, it is called a clear margin.
• Your surgeon may also remove lymph nodes in your armpit (axilla) to see if cancer has spread to the lymph nodes.
• The surgeon will close the skin with stitches. These may dissolve or need to be removed later. A drain tube may be placed to remove excess fluid.

Your doctor will send the lump to a laboratory for testing.

Why the Procedure Is Performed

Surgery to remove a breast cancer is usually the first step in treatment.

The choice of which surgery is best for you can be difficult. Sometimes, it is hard to know whether lumpectomy or mastectomy is best. You and the health care providers who are treating your breast cancer will decide together.

• Lumpectomy is often preferred, because it is a smaller procedure and it has about the same chance of curing breast cancer as a mastectomy.
• Mastectomy, when all breast tissue is removed, may be done if the area of cancer is too large to remove without deforming the breast.

You and your doctor should consider:

• The size of your tumor, where in your breast it is located, whether you have more than one tumor in your breast, how much of your breast the cancer affects, and the size of your breasts.
• Your age, family history, whether you have reached menopause, and your overall health.

Risks

Risks for any surgery are:

• Bleeding
• Infection
• Reactions to medications

Risks for this procedure are:

• The appearance of your breast may change. After surgery, you may notice dimpling, a scar, or a difference in shape between the two breasts.
• You may also have numbness in the breast area.

The breast tissue that is removed will be looked at under a microscope after the surgery. If the cancer is too close to the edge of this tissue, you may need another procedure to remove more breast tissue.

Before the Procedure

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs or herbs you bought without a prescription

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always try to stop smoking. Your doctor or nurse can help.

On the day of the surgery:

• Follow your doctor's instructions about eating or drinking before surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive for the procedure.

After the Procedure

The recovery period is very short for a simple lumpectomy. You should have little pain. If you do feel pain, you can take pain medicine, such as acetaminophen (Tylenol).

The skin should heal in about a month. You will need to take care of the surgical cut area. Change dressings as your doctor or nurse tells you to. Watch for signs of infection when you get home (such as redness, swelling, or drainage).

You may need to empty a fluid drain a few times a day for 1 to 2 weeks. Your doctor will remove the drain later.

Most women can go back to their usual activities in a week or so. Avoid heavy lifting, jogging, or activities that cause pain in the surgical area for 1 to 2 weeks.

If cancer is found, you will need to schedule follow-up treatment with your doctor.

Outlook (Prognosis)

The outcome of a lumpectomy for breast cancer depends mostly on the size of the cancer and whether it has spread to lymph nodes underneath your arm.

A lumpectomy for breast cancer is usually followed by radiation therapy and chemotherapy, hormone therapy, or both.

Women usually do not need breast reconstruction after lumpectomy.

References

Carlson RW, Allred DC, Anderson BO, Burstein HJ, Carter WB, Edge SB, et al. Breast cancer. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology, v2. 2010.

Iglehart JK, Smith BL. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 34.

Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24(31):5091-5097.

Abeloff MD, Wolff AC, Weber BL, Zaks TZ, Sacchini V, McCormick B. Cancer of the breast. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 95.