A lumpectomy, also called breast-conserving surgery, removes a breast tumor along with a small amount of surrounding normal tissue while leaving most of the breast intact. It can be used for certain cases of ductal carcinoma in situ (DCIS) and invasive breast cancer. Although lumpectomy is often less extensive than mastectomy, it remains an important cancer treatment decision.
Lumpectomy is not suitable for every breast cancer diagnosis.
The decision depends on factors such as:
For many people with early-stage breast cancer, breast-conserving surgery followed by radiation can provide survival outcomes comparable to mastectomy. However, individual circumstances can change which procedure is recommended.
A large tumor relative to breast size, cancer in multiple areas, inflammatory breast cancer, or an inability to receive radiation may influence the surgical decision.
A second opinion from another breast specialist can also be reasonable when there is uncertainty about the surgical approach.
A key part of lumpectomy is the pathology examination performed after surgery.
The removed tissue is examined under a microscope to determine whether cancer or DCIS reaches the edges, known as the surgical margins.
A negative or clear margin means cancer cells are not found at the edge of the removed tissue.
A positive margin means cancer cells are present at the edge. In some situations, another procedure called re-excision may be recommended to remove additional tissue.
The possibility of additional surgery is therefore an important issue to discuss before the initial procedure.
Questions for the surgical team can include:
Knowing the possible outcomes in advance can make the postoperative pathology process less surprising.
Some people undergoing lumpectomy also have a sentinel lymph node biopsy.
The sentinel lymph nodes are the first lymph nodes to which cancer is most likely to spread from the breast. During the procedure, selected lymph nodes are removed and examined for cancer cells.
Sentinel lymph node biopsy is commonly considered for people with early-stage breast cancer, although it is not necessary in every situation.
If cancer is detected in a sentinel node, additional treatment may be considered depending on the cancer's characteristics and the overall treatment plan.
Lymph-node surgery can also increase the risk of complications such as lymphedema, swelling, discomfort, numbness, or restricted movement.
The surgical team can explain whether lymph-node evaluation is recommended and what the procedure would involve.
Lumpectomy is frequently only one part of breast cancer treatment.
Radiation therapy is commonly recommended after breast-conserving surgery because it reduces the risk of cancer returning in the treated breast.
Depending on the pathology and biomarker results, additional treatment can include:
The need for these treatments depends on factors such as tumor type, grade, stage, hormone-receptor status, HER2 status, lymph-node findings, and other pathology results.
In some cases, chemotherapy or another systemic treatment is given before surgery. Preoperative treatment can sometimes shrink a tumor and make breast-conserving surgery more feasible.
For this reason, the surgical date should be viewed within the context of the entire cancer-treatment plan rather than as an isolated procedure.
Radiation can involve repeated treatment sessions over a period determined by the radiation oncology team.
Treatment schedules vary according to the individual diagnosis and radiation approach.
Anyone considering lumpectomy should ask:
Understanding the likely treatment schedule can also help with transportation, work, caregiving, and other practical arrangements.
Lumpectomy is often performed as an outpatient procedure, and many people return home the same day. Recovery varies according to the extent of surgery and whether lymph-node surgery is performed. NCI notes that many people can return to most normal activities within about two weeks.
Possible short-term effects include:
The breast can also have a scar, indentation, or change in shape depending on the amount and location of tissue removed.
Before surgery, it can be helpful to discuss the expected cosmetic result with the surgeon. Oncoplastic techniques may sometimes be considered when a larger amount of tissue needs to be removed or when maintaining breast shape is a significant concern.
The surgical team may provide instructions regarding:
Medication and supplement instructions should come directly from the surgical and anesthesia teams rather than being changed independently.
Preoperative testing can vary depending on the person's health and the type of surgery. Blood tests, an ECG, or other assessments may be requested when appropriate.
A written list of questions can make the surgical consultation more productive.
For eligible people, the choice between lumpectomy and mastectomy can involve both medical and personal considerations.
Lumpectomy preserves most of the breast and is commonly followed by radiation.
Mastectomy removes the entire breast and may reduce the need for radiation in some early-stage situations, although radiation can still be recommended depending on the cancer.
Factors affecting the decision can include:
For many early-stage breast cancers, lumpectomy followed by radiation and mastectomy provide comparable long-term survival outcomes.
Some pain, tenderness, tightness, or discomfort is common after breast surgery.
Pain management may involve medication recommended by the surgical team and supportive measures such as appropriate postoperative clothing.
The amount of discomfort varies according to the extent of surgery and whether lymph nodes were also removed.
Persistent, severe, or worsening pain should be reported to the medical team.
Postoperative instructions should always take priority, but medical attention may be needed if symptoms such as the following develop:
These symptoms can have several causes, and the surgical team can determine whether evaluation is necessary.
A lumpectomy can preserve most of the breast while effectively treating certain types of breast cancer and DCIS. However, the decision involves more than the operation itself.
The five major areas to consider are whether lumpectomy is appropriate, how surgical margins will be evaluated, whether lymph-node surgery is needed, what additional treatment may follow, and what recovery and cosmetic changes may occur.