What is a lumpectomy?
Lumpectomy – is the most commonly used form of breast-conserving surgery for breast cancer treatment. This removes only the part of the breast where the cancer is located and a small part of healthy tissue. After a lumpectomy, removed tissue is usually subjected to histological examination for the presence of cancer cells in the edges of the removed part of breast.
Operations with preservation of organs lie in the fact that some part of the female breast remains. Perhaps you may have heard from surgeons the terms such as excisional biopsy, lumpectomy, and partial mastectomy. A lumpectomy is technically equal to partial mastectomy, because this operation removes a part of the breast. However, the removed part of the breast can be very different. For example, a quarter of breast is removed in some cases. In addition, breast lumpectomy is usually complemented by a course of radiation therapy to be completely sure that destroyed all tumor cells.
The second surgery (the so-called re-excision) takes place if cancer cells are found in the edges of the removed part of breast. In most cases, 5 – 7 sessions of radiotherapy are performed after lumpectomy. Thus, the combination of lumpectomy and radiation therapy is called a breast-conserving surgery.
The procedure of lumpectomy surgery
Lumpectomy surgery takes between 15 to 40 minutes, depending on the size of the removed tumor, its location and other factors. Various clinics have their own nuances of preparation for this intervention and its implementation. Moreover, the postoperative period also depends on the patient.
The incision is usually made in the form of an arc that plays a great role in terms of beauty, because it has a better impact on wound healing. Usually, electrotome is used while section – it can significantly reduce bleeding during surgery.
After incision of the skin and soft tissue, the surgeon detects the tumor and excises it together with a part of healthy tissue. If the tumor is not detectable, then the doctor usually determines its location using mammography or ultrasound before the surgery.
The drainage (a rubber tube) is installed in the place where the tumor was excised. It is done to prevent formation of hematoma, because the blood will flow through the drainage in case of the blood accumulation. The wound is sutured after the removal of the tumor.
Lumpectomy vs. mastectomy: what to choose?
Today, women diagnosed with breast cancer have a right to participate in choosing the method of operation, in particular, choosing the complete removal of the affected breast (mastectomy) and the breast-conserving surgery (lumpectomy) followed by course of radiation therapy (radiotherapy).
Although the vast majority of women, of course, prefer less radical method of breast cancer treatment, it is still necessary to take into account some important factors influencing outcome and the choice of surgery. These factors probably have a moral character, for example:
- The presence of contraindications to radiation therapy for patient;
- Whether will the breast reconstructive surgery take place;
- Whether will the mastectomy help to reduce woman’s anxiety about the recurrent breast cancer;
- Whether is it very important to save the breast for woman?
Advantages and disadvantages of lumpectomy
The main advantage of lumpectomy – is a preservation of the breast form and its sensitivity. Lumpectomy surgery is less invasive compared to mastectomy, that’s why the lumpectomy recovery time is shorter and the lumpectomy recovery occurs easier than after mastectomy.
However, along with the benefits, we must not forget about the drawbacks, for example:
- Radiation therapy is inevitable after lumpectomy within 5 – 7 weeks, because it leads to removal of all cancer cells. However, radiation therapy has some unpleasant side effects (nausea, vomiting, malaise, partial or complete hair loss, and others). Though over time, these problems will disappear and the hair will be restored.
- Women, who have undergone lumpectomy, have much greater risk of local recurrence of breast cancer compared with women, who have had a mastectomy.
- Repeated irradiation is carried rather more difficult in case of recurrence or development of a new cancer in the same place where previously lumpectomy with radiation exposure were performed.
Advantages and disadvantages of mastectomy
Mastectomy (a complete removal of the breast) will certainly give more chances to the absolute recovery than lumpectomy. Many women choose mastectomy for their own sedation. Unfortunately, however, it should be noted that a mastectomy doesn’t give a full guarantee that secondary breast cancer will not appear. Moreover, after this operation, as in the case of a lumpectomy, you may also need a course of radiotherapy. It depends on the results of histological examination of the removed tissue.
Mastectomy has three quite significant disadvantages:
- A woman loses her breast after this operation.
- The operation is more extensive, lasts longer, and is characterized by a large number of side effects comparing with lumpectomy. In addition, a mastectomy has a longer postoperative period.
- Woman needs to have further surgical intervention (maybe in several stages) if she plans to make a breast reconstruction.
Saving of the skin during mastectomy allows to achieve the best results of breast reconstruction surgery. During the operation, the skin is removed exclusively in the areas of nipple and areola and incision of biopsy, in order to prevent the further spread of the cancer. The remaining part of the skin allows to improve significantly the effect of reconstructive surgery with help of local tissue and implants.
The surgeon usually removes more skin to make the breast surface flat if a woman doesn’t want to do breast reconstruction after mastectomy. But if a woman plans yet to have reconstructive surgery, the surgeon may perform mastectomy with preservation of the skin.
The effectiveness of lumpectomy
The main principle of breast cancer treatment is that whole breast should be subjected to treatment. This can be achieved by:
- Mastectomy – is complete removal of the breast;
- Lumpectomy followed by radiotherapy.
Recently, we conducted a lot of studies to identify the effectiveness of lumpectomy with radiation therapy and of mastectomy during breast cancer treatment. The results showed that lumpectomy combined with radiation therapy is really as effective as mastectomy in patients, who has one tumor in one of breasts and in cases when the tumor is less than 4 cm and removed with ‘healthy’ edges.
Currently, these studies continue. New research on this topic also confirm these results regarding women younger than 50 years (that is, pre-menopausal). 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 some doctors adhere to conservatism in this regard and try to carry out a mastectomy. However, recent studies have shown that women older than 75 years old, who had lumpectomy with radiation therapy, live longer than those who did not pass the course of radiation exposure. These studies emphasize the importance of this type of surgery for all women with breast cancer, regardless of their age.
It’s up to you what you will choose and which procedure is more appropriate for you: lumpectomy or mastectomy. It is important to take into account all the advantages and disadvantages of these surgeries, and you decision should be necessarily discussed with your doctor.