There are many different treatment options available for breast cancer, including a type of surgery called a lumpectomy. While surgery can be anxiety-inducing, rest assured that lumpectomies are extremely safe and usually take no more than an hour.
Here, Anna Weiss, MD, a breast surgeon in the Breast Oncology Program at the Susan F. Smith Center for Women’s Cancers at Dana-Farber/Brigham and Women’s Cancer Center, answers some of the most commonly asked questions about lumpectomies — including what to expect if you need one.
What exactly is a lumpectomy?
A lumpectomy is a surgical procedure used to treat breast cancer that involves the removal of the tumor and a ring of healthy tissue around the tumor from the breast. The procedure typically takes under an hour and takes place via a relatively small incision generally between three to four centimeters. The incision is usually right over the tumor, but it can also be made in the areola, under the breast, or in the armpit.
When placing the incision, the surgeon will always do what is best for your cancer, and secondarily what is best for cosmetic outcomes.
What is the difference between a lumpectomy and a mastectomy?
The main difference between a lumpectomy and a mastectomy is the amount of breast tissue that is removed during surgery. Most of the breast tissue is conserved in a lumpectomy, as opposed to a mastectomy, where all of the breast tissue is removed. Whether or not the patient will need a lumpectomy or mastectomy usually depends on the size of the cancer.
Patients will usually have a choice between a lumpectomy and a mastectomy in the case of smaller breast tumors. In addition to size, location of the tumor can factor in as well. If the tumor has become very large, a mastectomy may be the only surgical option.
Your preference matters when determining whether to get a lumpectomy or a mastectomy — but before making a decision, be sure to listen to your doctor’s recommendations for what option may be best for you.
Are lymph nodes removed during a lumpectomy?
They can be. Sometimes a lumpectomy is a two-part procedure. If you have a pre-invasive tumor, called ductal carcinoma in situ, then the cancer cells are contained inside the breast ducts and the lymph nodes do not need to be evaluated. If you have invasive cancer, the full procedure involves tumor removal and then a lymph node biopsy — taking a sample from the lymph nodes that are underneath the armpit (called the axilla).
In the case of a biopsy, anywhere from 1-5 lymph nodes will be taken and then sent off for testing to determine if the cancer has spread there. If the lymph nodes are known to be cancerous before surgery, more lymph nodes will be removed from the armpit. Typically, the lymph nodes are removed through a separate incision in the armpit.
Who is a candidate for a lumpectomy?
There are several different factors taken into consideration when deciding if a lumpectomy is a good choice for a patient. They include:
- The tumor size and the size of the breast. Someone with a small tumor and a larger breast is an ideal candidate for a lumpectomy. If the person getting the procedure has a very large tumor and a very small breast, a lumpectomy might not be the best option. Other options for someone who is not a great candidate for a lumpectomy could include being treated with chemotherapy to try and shrink the tumor enough to make a lumpectomy possible, or opting for a mastectomy.
- The location of the tumor. The location of the tumor in the breast can make the cosmetic outcomes better or worse. If the tumor is located near the breast bone or higher in the breast, lumpectomy may not be the best option.
- The patient’s family history and genetic profile. Even if a patient might otherwise be a candidate for a lumpectomy, they may not be depending on their family history and genetics.
- The patient’s choice. The doctor will recommend the procedure they think is most appropriate for you, but you also have a say in what you want to undergo.
What does the recovery look like?
During those first two weeks after the procedure, your doctor will ask you to refrain from any heavy lifting or intense activity. After that, you can usually slowly start to return to your normal routines.
The incision care is generally easy as well. You will have stitches under the skin holding the incision closed and then skin glue or Steri-Strip on the surface to keep the incision covered. (Skin glue is a type of medical-grade glue used to seal or protect wounds, whereas Steri-Strips are thin adhesive bandages used as a backup to dissolvable stitches.)
The stitches will absorb and dissolve on their own. The skin glue or Steri-Strips are used as an added layer of protection and they will fall off on their own. In those first few weeks, be sure to keep the incision area dry. Don’t put anything on it until your doctor says you can.
Lumpectomy recovery is dramatically shorter and usually less intense than mastectomy recovery.
Will I need additional treatment after a lumpectomy?
Yes, you will need radiation treatment after the lumpectomy. This is to ensure that any cancer cells that may have been missed in the surgery are destroyed. The radiation will typically go Monday through Friday for four to six weeks.
How will a lumpectomy change the shape of my breast?
Because this surgery conserves most of the breast tissue, the shape of your breast shouldn’t change dramatically. There may be a dent in the breast, especially when lying down, but the overall shape of the breast should be pretty well conserved. Your overall profile, breast shape, and cleavage should remain almost the same as it did before surgery.
Does a lumpectomy result in scarring? Is there anything I can do about it?
Yes, a lumpectomy will result in scarring. The surgery involves at least one incision and that will scar. There are a few things you can do to try and help minimize scarring. They include:
- Wearing a supportive bra so that the skin doesn’t stretch unnecessarily
- Using a variety of creams or gels that can help reduce scarring (your doctor will have recommendations)
- Silicone bandages
- Vitamin E
- Cocoa butter lotions
Most doctors will allow use of these products to help minimize scarring, but make sure to only use them after your doctor has cleared you. Putting these types of products on a fresh incision is not good for the wound.
If you have any other specific questions about lumpectomies, be sure to bring them to the attention of a medical professional.
About the Medical Reviewer
Dr. Anna C. Weiss is a graduate of Case Western Reserve University School of Medicine in Cleveland, OH. She completed a residency in General Surgery at the University of California, San Diego School of Medicine in San Diego, CA and a fellowship in Breast Surgical Oncology at the University of Texas MD Anderson Cancer Center in Houston, TX.
She is board certified by the America Board of Surgery. Her clinical interests include the surgical treatment of breast cancer, axillary surgery and inflammatory breast cancer. Her research interests include surgical decision making for genetic mutation carriers, inflammatory breast cancer, large population database research, and the application and integration of collaborative clinical trial results on real world data.