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    Breast lump removal

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

    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

    Description

    If the breast cancer can be seen on imaging tests but the doctor cannot feel it when examining you, 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 and removes the cancerand some of thenormal breast tissue around it.The sample is sent to a pathologist who examines it and makes sure all the cancer has been removed.

    • When no cancer cells are found 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 extra fluid. Your doctor will send the lump to a laboratory for moretesting.

    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 for smaller breast lumps, because it is a smaller procedure and it has about the same chance of curing breast cancer as a mastectomy.
    • Mastectomy to remove all breast tissuemay 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 it is in your breast
    • If there is more than one tumor
    • How much of the breast is affected
    • The size of your breasts
    • Your age
    • Family history
    • General health, including whether you have reached menopause

    Risks

    Risks for any surgery are:

    • Bleeding
    • Infection
    • Reactions to medications

    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.

    Youmay need another procedure to remove more breast tissue if tests show the cancer is too close to the edge of the tissue already removed.

    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.

    Hunt KK, Green MC, Buchholz TA. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 19th ed. St. Louis, Mo: WB Saunders; 2012:chap 36.

    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.

    Cuzick J, DeCensi A, Arun B, Brown PH, Castiglione M, Dunn B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011. 12:496-503.

    Heisey RE, McCready Dr. Office management of a palpable breast lump with aspiration. CMAJ. 2010;182:693-696.

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    • Female Breast

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    • Open biopsy of the breas...

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    • Breast self-exam

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    • Breast self-exam

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    • Breast self-exam

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    • Breast lumps

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    • Lumpectomy

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    • Causes of breast lumps

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    • Breast lump removal - se...

      Presentation

      • Female Breast

        illustration

      • Needle biopsy of the bre...

        illustration

      • Open biopsy of the breas...

        illustration

      • Breast self-exam

        illustration

      • Breast self-exam

        illustration

      • Breast self-exam

        illustration

      • Breast lumps

        illustration

      • Lumpectomy

        illustration

      • Causes of breast lumps

        illustration

      • Breast lump removal - se...

        Presentation

      A Closer Look

      Talking to your MD

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          Tests for Breast lump removal

            Review Date: 12/10/2012

            Reviewed By: Robert A. Cowles, MD, Associate Professor of Surgery, Yale University School of Medicine, New Haven, CT. Review provided by VeriMed Healthcare Network. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, David R. Eltz, and Stephanie Slon.

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