You’ve probably heard doctors pronounced words, such as excisional biopsy, lumpectomy, partial mastectomy, re-excision, quadrantectomy, and wedge resection. Organ-conserving surgery means that after surgery some part of the female breast is left. Technically, lumpectomy is a partial mastectomy because only a part of the breast is removed. However, the size of the removed breast can be very different. For example, quadrantectomy is used to remove a quarter of the breast.
Lumpectomy is the most common form of conserving surgery for breast cancer. Only some part of the breast, where the tumor is located, and a small amount of normal tissue are removed. After a lumpectomy removed tissue is examined for the presence of cancer cells in the other areas of the breast. In addition, radiation therapy follows lumpectomy in order to be sure that all cancer cells are destroyed. If removed tissue has cancer cells, a second operation, so-called re-excision, is carried out. In most cases after lumpectomy, radiotherapy is necessary (5 – 7 sessions). Thus, the combination of lumpectomy and radiation therapy is called breast-conserving surgery.
Is lumpectomy effective?
The main principle of treatment for breast cancer is that the entire breast should be treated. The effective methods are: a mastectomy (a complete removal of the breast); lumpectomy is followed by radiation therapy. Recently, it was conducted a large number of studies in order to find the equivalent effect of lumpectomy with radiation therapy and mastectomy to treat breast cancer.
The results have shown that lumpectomy in combination with radiation therapy is really as effective as mastectomy in patients: with a tumor in the breast and if the tumor is less than 4 cm, removed with unaffected edges.
Currently, these studies are continued. New research on this subject also confirmed these results regarding women under the age of 50 (premenopausal). Other studies show that a lumpectomy with radiation therapy is effective even in women with a very small tumor size (less than 1 cm).
Often old doctors are rather conservative, they try to carry out a mastectomy. However, recent studies have shown that women over 75 after lumpectomy with radiation therapy live longer than those who did not have radiation therapy. This study emphasizes the importance of this type of surgery for all women with breast cancer, regardless of their age.
How does lumpectomy work?
Lumpectomy lasts 15 – 40 minutes, depending on the size of the tumor, its location and other factors. Various medical centers have their own nuances of preparation and conduct. Moreover, the postoperative period also depends on the individual characteristics of the patient.
The surgeon will probably operate with a kind of electric scalpel that uses heat to minimize bleeding (an electrocautery knife). Most surgeons use curved incisions (like a smile or a frown) that follow the natural curve of the breast and allow for better healing. If the tumor can be seen or felt, the surgeon will remove it along with a rim of healthy tissue around it.
Sometimes, but not always, a rubber tube called a drain will be surgically inserted into the breast area or armpit to collect excess fluid that can accumulate in the space where the tumor was. The drain is connected to a plastic bulb that creates suction to help remove fluid. Finally, the surgeon will stitch the incision closed and dress the wound.
Potential complications after lumpectomy
Typically, loss of sensitivity may be experienced in the affected area, which depends on the size of the tumor. Gradually, skin sensitivity is restored completely or partially. After the surgery the shape of the breast can change. It may be smaller, as the removal of a certain part of the breast takes place during surgery. However, the breast can be even larger than before surgery because of temporary swelling.
Lumpectomy for young breast cancer patients
The treatment is more difficult for young patients suffering from breast cancer because it tends to recur and metastasize. Thus, doctors highly recommend more extensive surgery which removes the entire breast tissue (a mastectomy).
The study mentioned below shows that the choice of young patients (under the age of 40) – lumpectomy instead of mastectomy for early breast cancer – is rather right.
This study shows that patients under the age of 40, who chose lumpectomy instead of mastectomy, have almost the same risk of recurrence as patients over 40 who have undergone breast-conserving surgery as well. After five years there was a relapse in 9% of cases. After 10 years, it was 18%. This means that after 10 years over 80% of women did not go through the recurrence of breast cancer. In addition, doctors recommend young patients having a mastectomy in case they are at high risk of developing a new tumor in the same breast, if it was not removed completely. The study has shown that the risk of a new breast cancer in these patients is only 7%.
While a lumpectomy may be a good option for some young patients with early stages of breast cancer, it is important to keep in mind two important aspects of this study:
- Patients in this study suffered from stage I or II breast cancer. It can’t be said that the results of this study are suitable for stage III breast cancer, although some types of stage III breast cancer may be related to the early stages.
- Regardless of age, this study has shown that lumpectomy is as effective as mastectomy, while lumpectomy is often combined with radiation therapy and chemotherapy. It is important to note that radiation therapy and chemotherapy are used after the main (surgical) treatment, it is called adjuvant therapy.
So, regardless of age, if you have breast cancer at an early stage, you decide with your doctor which treatment option is better for you. Furthermore, regardless of the type of surgery, radiotherapy or chemotherapy is used. In conclusion, breast cancer in younger patients is more severe, so that doctors often recommend radical surgery. However, this study shows that conserving surgery in young patients has the same effect as mastectomy.
Lumpectomy with radiation therapy is an excellent method of treatment for breast cancer, but this method is not suitable for all patients.
Lumpectomy is not carried out:
- when you have undergone radiation therapy for the same breast with early stages of cancer.
- if you have an extensive breast cancer or two separate tumors in the same breast.
- when you have a very small size of breasts and a large tumor, so that lumpectomy leads to violation of the form of your breast.
- if there were several attempts to remove the tumor, but it was impossible.
- if the patient suffers from connective tissue diseases such as lupus erythematosus or systemic vasculitis, as it leads to side effects of radiation therapy.
- if the patient is pregnant.
- when you do not have the possibility to undergo radiation therapy every day.
- when you are more likely to have a mastectomy.
Re-excision is additional surgery. If cancer cells are found in the margins extending out to the edge of the breast tissue that was removed, your surgeon will perform re-excision to remove the remaining cancer. It may mean that the patient is at high risk of recurrence or metastasis. Therefore, the edges must be cancer-free.
Questions to ask your surgeon about lumpectomy
Here are some questions to ask your surgeon as you plan for lumpectomy surgery:
- How many times have you performed lumpectomy?
- What are the risks of lumpectomy?
- How should I prepare for surgery?
- How long will surgery take?
- How much tissue will be removed?
- How will you decide how wide the lumpectomy margins should be?
- Will you remove any underarm lymph nodes (axillary node dissection) along with the lump?
- Will I have anesthesia? If so, what kind?
- Will I need blood transfusions? Should I donate my own blood before surgery?
- How will my breast look after lumpectomy?
- Will I need to stay in the hospital after surgery?
- How long will it take to recover?
- Are there any precautions I should take as I recover? Will you give me written instructions to follow?
- Are there exercises I need to do after surgery?
- When can I return to my normal routine and activities?
- Will I be at risk for lymphedema after surgery?