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How is Lumpectomy Performed?
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This illustration shows how lumpectomy is performed by removing the tumor and
margin of surrounding normal breast tissue. Some of the axillary (underarm) lymph nodes
may also be removed in patients who undergo lumpectomy. Illustration courtesy of the
NCI/NIH. |
Lumpectomy may be performed using a local anesthetic, sedation, or general anesthesia,
depending on the extent of the surgery needed. The surgeon makes a small incision over or
near the breast tumor and excises (cuts free) the lump or abnormality along with a margin
of at least one centimeter (approximately one half inch) of normal surrounding breast
tissue (see the section above for information on margins). Unlike after mastectomy, a
drainage tube is usually not necessary after lumpectomy.
A seroma (clear fluid trapped in the wound) usually fills the surgical cavity after the
operation and helps to naturally remold the breast’s shape. Gradually, the seroma is
absorbed and the body replaces it with scar tissue. This natural healing process and
formation of scar tissue occurs over a period of months, so that the final results of the
surgery may not be apparent for some time. Depending on such factors as the location of
the mass, its initial size, the type of incision used, etc., the final result will be
different for each person.
| Possible Side
Effects of Lumpectomy Include: |
- temporary swelling of the breast
- breast tenderness
- hardness due to scar tissue that forms
in the surgical site
|
Patients are usually able to go home the same day or one to two days following
lumpectomy. Most women are able to resume normal activities within two weeks. Wound
infection or bleeding is not common with lumpectomy. The extent of breast soreness
correlates with the amount and location of tissue removed during surgery, whether axillary
(underarm) lymph node surgery was performed, and an individual’s tolerance to pain.
Major soreness usually ceases after two to three days and should be checked by a physician
if there is any increase in pain over time. Because lumpectomy is usually intended to
preserve the cosmetic appearance of the breast, surgeons generally do not recommend
lumpectomy when over one fourth of the breast must be removed. In these cases, mastectomy,
along with the option of reconstruction, may be
preferable.
In rare instances, women may experience recurring seromas after lumpectomy. Seromas are
collections of fluid in the cavity (empty space) left behind by the surgery. These
collections are easily drained (aspirated) in the surgeon’s office. If a seroma
recurs, surgeons may use several methods including compression or sclerosis (the injection
of ethanol, autologus fibrin clot, or fibrin sealant) to fill and harden the space in the
breast. At times, these treatments can be uncomfortable, but they are rarely needed.
Radiation Therapy After Lumpectomy
Lumpectomy (and sometimes mastectomy) is typically followed by six to seven weeks of radiation therapy immediately following surgery to help
ensure that any remaining cancer cells are destroyed and to help prevent the chance of a
cancer recurrence. Treatment with radiation usually begins
one month after surgery, allowing the breast tissue adequate time to heal. Treatments are
given daily and each treatment generally lasts a few minutes; the entire radiation session
after machine set-up typically lasts 15 to 30 minutes. The procedure itself is pain-free.
While the radiation is being administered, the technologist will leave the room to monitor
the patient on a closed-circuit television. However, patients should be able to
communicate with the technologist at any time over an intercom system.
| Common Side Effects of Radiation Therapy |
- Hair loss to the area being treated
- Fatigue
- Skin reactions (such as rash or redness) in the treated area
- Loss of appetite
- Nausea
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Most of the side effects associated with radiation therapy are
temporary, and many patients do not experience significant discomfort after radiation
sessions. Click here for more information on radiation
therapy.
Lumpectomy and Lymph Node Removal
When breast cancer cells begin to escape from the primary tumor site in the breast, they
first travel to the lymph nodes under the upper arm.
Therefore, it is often necessary to remove some or all of the axillary (underarm) lymph
nodes during lumpectomy or mastectomy to determine if or to what extent the cancer has
spread.
Lymph node removal usually requires a separate incision when it is performed during the
same procedure as lumpectomy. There are two procedures for removing lymph nodes in breast
cancer patients: axillary node dissection and sentinel node biopsy.
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Axillary node dissection: This is the
standard way to remove axillary lymph nodes. Typically, between 10 to 30 lymph nodes are
removed and examined in a pathology laboratory to determine whether they contain cancer
cells.
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Sentinel lymph node biopsy: This is
a technique that involves the injection of a blue dye, radioactive
tracer, or both, to identify the "sentinel" lymph nodes (first nodes) draining the breast. Using this
method, only the first one to three lymph nodes in the lymphatic chain are removed. Research has shown that
checking the sentinel lymph nodes allows physicians to accurately determine whether the
axillary (armpit) lymph nodes contains cancer while causing fewer side effects
such as lymphedema (chronic swelling) of the arm. If the sentinel nodes are positive
(contain cancer cells), then additional surgery is performed to remove (dissect) the
remaining axillary lymph nodes. If the removed axillary lymph nodes are
negative (do not contain cancer cells), then no additional lymph nodes are removed, reducing
the side effects of axillary dissection. Sentinel lymph node biopsy has become more
common in recent years. However, it is not always appropriate.
Click here for more information about this procedure.
The most common side effect of lymph node removal is lymphedema
(chronic swelling) of the arm. Between 10% and 20% of patients who have lymph nodes remove
develop lymphedema, including some patients who only have a sentinel lymph node biopsy.
The risk of lymphedema is greater if the patient also undergoes radiation therapy and/or
the lymph nodes contained cancer cells upon final examination. To help manage lymphedema
and prevent long-term suffering, patients should report symptoms as soon as they occur. In
addition, special exercises should be performed
shortly after recovering from surgery to help encourage and maintain lymphatic flow of the
affected side of surgery.
Early Signs of
Lymphedema |
- Feeling of tightness in the arm
- Pain, aching or heaviness in the arm
- Swelling and redness of the arm
- Less movement/flexibility in the arm, hand, wrist
- Rings, bracelets or sleeves do not fit
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In addition to lymphedema, other common side effects of lymph node
removal include limitations of arm/shoulder movement, and numbness of the upper arm skin. Click here to learn more about lymphedema.
Additional Resources and References
Updated: January 31, 2008
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