comscoreLumpectomy

Lumpectomy

Lumpectomy, also called breast-conserving surgery, is a procedure that removes the breast cancer along with a small amount of the healthy tissue surrounding it.

Lumpectomy (also called breast-conserving surgery) is surgery to remove a breast cancer tumor (the lump) and the rim of healthy tissue surrounding it (called the margin). 

Unlike mastectomy, which removes the entire breast, lumpectomy removes only the cancer to preserve as much of your breast as possible.

Because only part of the breast is removed, lumpectomy is also sometimes referred to as a partial mastectomy. The amount of tissue the surgeon removes can vary greatly. The following procedures are considered forms of lumpectomy: 

  • wedge resection, in which a larger wedge of tissue is removed

  • quadrantectomy, in which roughly a quarter of the breast is removed

Removing a margin of healthy tissue surrounding the cancer helps ensure that the surgeon removes all of the cancer. During lumpectomy surgery, some surgeons use a technique called cavity shave margins: Surgeons shave a thin layer of tissue from the sides of the area from where they remove the tumor so no cancer cells are left behind. 

During a lumpectomy, the surgeon also usually removes one to three underarm lymph nodes. Removing these lymph nodes is known as a sentinel lymph node biopsy. A doctor called a pathologist examines these lymph nodes to check for any signs of cancer. If the pathologist finds cancer, you may need to have more lymph nodes removed through a procedure called axillary lymph node dissection.

If you’re considering lumpectomy, it’s a good idea to talk to your surgeon about how much tissue needs to be removed and how it might affect your breast's appearance. In some cases, surgeons can use plastic surgery techniques during the lumpectomy to achieve a better cosmetic result. Called oncoplastic lumpectomy, this approach may make breast-conserving surgery possible even if you have a larger tumor or multiple areas of cancer.

 

Lumpectomy plus radiation therapy

Doctors typically recommend radiation therapy after lumpectomy to help reduce the risk of the cancer coming back (recurrence). The goal of radiation therapy is to destroy any cancer cells that might remain in the breast after the surgeon removes the tumor.

Research shows that, for most women with early-stage breast cancer, lumpectomy plus radiation offers better survival than mastectomy. Early-stage breast cancer is cancer that hasn’t spread beyond the breast or underarm lymph nodes.

Back in 2002, the influential NSABP-06 Trial found that after 20 years of follow-up, total mastectomy did not offer an advantage over lumpectomy in terms of how long women lived (overall survival), how long they remained free of recurrence (disease-free survival), and whether they developed metastatic disease (cancer spreading beyond the breast). 1

Other studies have confirmed those results:

  • A 2013 study of more than 112,000 women with stage I or stage II breast cancer found that overall survival and disease-free survival were higher for women who had lumpectomy plus radiation than for those who had mastectomy. 2

  • A 2014 analysis of over 132,000 women found that five- and 10-year breast cancer-specific survival rates were higher for women diagnosed with early-stage cancer who had lumpectomy plus radiation than for those who had mastectomy. 3

  • A 2021 study of nearly 49,000 women diagnosed with early-stage breast cancer in Sweden found that overall survival and breast cancer-specific survival rates were higher for those who had lumpectomy and radiation than for those who had mastectomy with or without radiation.

When choosing the type of radiation therapy and a schedule that makes sense, you and your doctors consider your individual situation, your age, and the cancer’s characteristics. Examples include:

  • External whole-breast beam radiation: Traditionally, people received this form of radiation five days a week for five to seven weeks. A newer, more common approach is to have the same dose of radiation in just three to four weeks, which is called an accelerated or hypofractionated radiation schedule.

  • Accelerated partial-breast radiation: During a one- to two-week period, people receive a larger dose of radiation directly to the part of the breast where the cancer was — instead of to the entire breast. Certain women diagnosed with early-stage breast cancer may be candidates for this form of radiation.

  • Brachytherapy or internal radiation: Brachytherapy uses radiation in the form of pellets to destroy cancer cells and shrink tumors. The pellets (also called seeds) are placed in the area where the cancer was with an applicator device or tiny tubes (called catheters). The pellets emit radiation into the surrounding tissue. People usually receive this treatment twice a day for five days.

  • Intraoperative radiation therapy (IORT): People receive this type of radiation therapy during lumpectomy surgery, right after the surgeon removes the cancer. Although the underlying breast tissue is still exposed, a single high dose of radation is given directly to the area where the cancer was.

Hypofractionated Radiation Therapy

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Radiation therapy isn’t usually recommended for certain groups, including: 

  • people diagnosed with DCIS (ductal carcinoma in situ) that has a low risk of recurrence

  • women older than age 65 diagnosed with early-stage, estrogen receptor-positive breast cancer

 
 
Is lumpectomy plus radiation right for you?

Your doctor can help you decide which surgery is best for your unique situation. Lumpectomy plus radiation therapy may be right for you if:

  • you have one tumor that is relatively small compared with the size of your breast 

  • you prefer to keep as much of your natural breast tissue as possible

  • you want to avoid mastectomy and reconstruction, which is a more involved process

  • you’re able to commit to daily radiation treatments for a period of a few weeks

With some exceptions, you may not be a candidate for lumpectomy plus radiation if:

  • you’ve already had radiation to the same breast for an earlier breast cancer

  • you have a large amount of cancer in the breast or multiple areas of cancer in the same breast 

  • you have a small breast and a large tumor and removing the tumor would be extremely disfiguring (and oncoplastic lumpectomy isn’t an option for you)

  • you have inflammatory breast cancer, which requires mastectomy

  • you have a connective tissue disease involving the skin, such as scleroderma or lupus

  • you’re pregnant, which makes radiation therapy unsafe

  • you can’t commit to a daily radiation therapy schedule

  • you have a higher-than-average risk of developing breast cancer in the future, including a strong family history or a confirmed genetic mutation associated with increased breast cancer risk

  • your surgeon has made several unsuccessful attempts to remove the breast cancer with lumpectomy

Although lumpectomy plus radiation is just as effective as mastectomy for most women, some women decide to have a mastectomy for better peace of mind about future breast cancer screenings. About half of the women in the United States who are eligible for lumpectomy choose mastectomy instead, according to the National Center for Health Research (NCHR). 4 Mastectomy is a valid choice if it’s right for you, but it’s important to make an informed decision. The NCHR reported that women are more likely to have a mastectomy if they have an older surgeon, are treated at a community hospital instead of an academic medical center, and don’t have a private health insurance plan. It’s important to explore all of your choices so you can decide whether mastectomy is the best option for you.

 

What to expect with lumpectomy

A lumpectomy is typically an outpatient procedure, which means you go home the same day. If you’re considering a lumpectomy, there are things you can expect before, during, and after the surgery.

Learn more
 

Getting your pathology results

After lumpectomy surgery, you receive a pathology report that explains the breast cancer's characteristics, such as:

  • the size of the tumor

  • tumor grade: a measurement of how much the cancer cells resemble normal, healthy cells

  • hormone receptor status: whether or not the breast cancer cells have receptors for the hormones estrogen and progesterone, meaning that these hormones are signaling the cancer to grow

  • HER2 status: whether the cells have too many copies of a gene known as HER2, which can promote cancer cell growth

  • margins: whether they are positive or negative

  • lymph node status: if the surgeon removed lymph nodes, the report says how many nodes, if any, have cancer in them

These and other breast cancer characteristics help you and your doctor decide on a treatment plan that's appropriate for you.

 
 
 

Re-excision lumpectomy

Up to 20% of people who have lumpectomy require a second surgery — called re-excision lumpectomy — because of positive margins. 5

After lumpectomy, the pathologist carefully examines all of the tissue the surgeon has removed from the breast to see if cancer cells are present in the margins — a rim of normal, healthy tissue surrounding the cancerous tumor. The tumor and surrounding tissue are rolled in a special ink so the margins are clearly visible when the pathologist checks thin slices of the sample under a microscope.

If there are no cancer cells in the margins or no ink on the tumor, the margins are considered to be negative, clear, or clean. If there are cancer cells in the margins or ink on the tumor, the margins are considered to be positive. To get clean margins, your surgeon may recommend more surgery, called re-excision lumpectomy. Some surgeons refer to re-excision as clearing the margins. If there are still positive margins after re-excision, your surgeon may need to do another re-excision or perform a mastectomy.

Surgeons follow national guidelines for negative margins.

  • Guidelines for invasive breast cancer consider margins to be negative when there is no ink on the tumor or no cancer present in the tissue the surgeon removed.

  • Guidelines for DCIS consider a 2-millimeter margin to be negative.

  • Guidelines for cases where there is invasive cancer and DCIS consider margins to be negative when there is no ink on the tumor. 6 7

 

Lumpectomy risks

Like all surgeries, lumpectomy carries certain risks:

  • Seroma: A seroma is a buildup of fluid in the space where the surgeon removed tissue that typically happens after surgery. In some cases, there can be a large buildup of fluid that has to be drained.

  • Infection: There is some risk of infection at the incision site. An infection of the skin, known as cellulitis, can develop in some people.

  • Loss of sensation: There is usually some numbness and loss of sensation in part of the breast after lumpectomy, depending on the size of the removed lump. Some or most of the feeling may return over time.

  • Scars, indentation, dimpling, and other cosmetic changes: Lumpectomy can lead to cosmetic changes that become visible over time as the skin heals. 

  • Uneven breasts: Your breasts may not be the same size and shape as each other after surgery. The affected breast can look smaller after lumpectomy. You may not notice this right away because swelling after surgery might make your breast temporarily appear larger. Radiation therapy also can change the affected breast’s size.

  • Nerve pain: Some people experience burning or shooting pain in the arm, armpit, or chest wall that usually goes away in the weeks or months after surgery. Sometimes nerve pain may last longer.

  • Lymphedema: If the surgeon removed underarm lymph nodes, you may develop lymphedema. This buildup of lymph fluid can cause swelling in the arm, hand, or upper body.

 

Questions to ask your surgeon about lumpectomy

Here are some questions you may want to ask your surgeon as you prepare for lumpectomy surgery:

  • How many times do you perform lumpectomy in an average month? What percentage of your patients require re-excision?

  • How do you know whether you have achieved clean margins? Do you use any technology during surgery to help ensure clean margins?

  • Do you use the shave margins technique (which means shaving another thin layer of tissue from the area around the tumor)? 

  • What are the risks of lumpectomy? 

  • How should I prepare for lumpectomy surgery?

  • How long does a lumpectomy take?

  • How big is the tumor relative to my breast size? How much tissue do you need to remove?

  • Do you expect to remove any underarm lymph nodes (sentinel or axillary node dissection) along with the tumor?

  • Are you able to hide the scar and rearrange the tissue to minimize any dents or other cosmetic issues (oncoplastic lumpectomy) after surgery? If not, can you call in a plastic surgeon?

  • If I need to have a larger portion of breast tissue removed (20% or more), are you able to perform an oncoplastic lumpectomy to reduce or lift the breast and bring the other breast into balance? Can you work with a plastic surgeon?

  • What kind of anesthesia can I expect to have?

  • How can I expect my breast to look after lumpectomy? Will my breast’s appearance change over time?

  • What is the likely effect of radiation therapy on my breast after lumpectomy?

  • Do I need to stay overnight in the hospital after surgery?

  • How long does it take to recover?

  • Are there any precautions I should take as I recover? Can I get written instructions to follow?

  • How should I care for the surgical site and dressings? Will I need a surgical drain afterward? If so, how should I care for it?

  • Are there exercises I should do after surgery?

  • When can I return to my normal routine and activities?

  • What is my risk for developing lymphedema after surgery?

  • If I am not happy with the appearance of my breasts after a few months have passed, what options do I have?

 

Oncoplastic lumpectomy and reconstruction after lumpectomy

Lumpectomy can cause cosmetic changes to the breast, such as visible indentation, a tight scar, or distortions in the nipple’s appearance. Any cosmetic changes can depend on the cancer’s size and location, as well as the size of your breast compared to the tumor’s size. Radiation therapy after lumpectomy can also affect the breast’s appearance, including its size and shape, leading to uneven breasts (asymmetry). Uneven breasts might not become obvious until months after surgery and also can be affected by weight gain or loss.

Your reconstruction options include oncoplastic lumpectomy and reconstruction after lumpectomy:

Oncoplastic lumpectomy techniques can help minimize scars, indentation, dimpling, or other cosmetic changes that may result after lumpectomy. Oncoplastic lumpectomy also can help breasts look even, especially if the surgeon needs to remove a large amount of tissue. For example, surgeons can operate on the other breast to help restore symmetry — but some women decide to use a partial breast shaper instead.

If you aren’t happy with the way your breasts look after at least six months, you may want to consider revision reconstruction surgery with a plastic surgeon. Options include fat grafting or tissue transfer to fill in dents or divots or to remedy scarring or hardening. The surgeon can use a tissue flap or implant if the affected breast is distorted or shrunken. A plastic surgeon also can operate on the other breast to make sure both breasts are even.

 

Partial breast forms

Some people who have uneven breasts after a traditional lumpectomy may not necessarily want to have reconstructive surgery. In these cases, a partial breast form (or prosthesis) can help achieve a more even appearance.

Many of the manufacturers who make full breast forms for use after mastectomy also make partial forms, sometimes called partial breast shapers. These are silicone breast forms available in different shapes and sizes that you can attach directly to the skin with adhesive or place inside a post-mastectomy bra with pockets. 

A certified mastectomy fitter can give you a better idea about the full range of prosthetic options and ensure you get the best-fitting forms for you. Certification means that the fitter has completed education and training in fitting breast forms, completed many hours working with patients, and passed a exam. Many cancer centers have in-house boutiques with certified fitters. Some specialized lingerie shops and department stores have certified fitters on staff as well. The American Cancer Society’s Reach to Recovery program is also a good resource.

Most health insurance plans offer coverage for breast forms and bras after mastectomy and after lumpectomy. Still, it’s a good idea to check your health insurance company’s website or call a representative to find out exactly what your plan covers. To be eligible for health insurance coverage, you need a prescription from your doctor for the breast form and bra.

Some women prefer to use lightweight breast forms to add more volume and shape to a smaller breast. These breast forms are typically made of foam, polyurethane, or polyester and can be slipped inside a post-mastectomy bra with pockets. You can find these types of bras at various places, including Athleta, AnaOno, and The Busted Tank. In addition to being lightweight, breast forms are fairly inexpensive, washable, and easy to wear and replace. People who prefer breast forms also say they are especially comfortable to wear when they work out.

 
 

Written by: Kristine Conner, contributing writer

 
References
  1. Fisher B, Anderson A, Bryant J, et al. Twenty-year follow-up of a randomized trial comparing total mastectomy, lumpectomy, and lumpectomy plus irradiation for the treatment of invasive breast cancer. NEJM. 2002. 347(16):1233-41. Available at: https://doi.org/10.1056/nejmoa022152

  2. Hwang ES, Lichtensztajn DY, Gomez SL, et al. Survival after lumpectomy and mastectomy for early stage invasive breast cancer. Cancer. 2013. 119(7):1402-1411. Available at: https://doi.org/10.1002/cncr.27795

  3. Agarwal S, Pappas L, Neumayer L, et al. Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer. JAMA Surg. 2014. 149(3):267-274. Available at: https://doi.org/10.1001/jamasurg.2013.3049 

  4. National Center for Health Research. Mastectomy v. Lumpectomy: Who Decides? Available at: https://www.center4research.org/mastectomy-v-lumpectomy-who-decides/ 

  5. Sharsheret. 20% of women getting lumpectomies need a second surgery, but this risk can be lowered. Available at: https://sharsheret.org/20-of-women-getting-lumpectomies-need-a-second-surgery-but-this-risk-can-be-lowered/

  6. Moran MS, Schnitt SJ, Giuliano AE, et al. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer. Ann Surg Oncol. 2014. 21:704-716. Available at: https://doi.org/10.1245/s10434-014-3481-4 

  7. Morrow M, Van Zee KJ, Solin LJ, et al. Society of Surgical Oncology–American Society for Radiation Oncology–American Society of Clinical Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Ductal Carcinoma in Situ. Pract Radiat Oncol. 2016. 6(5):287-295. Available at: https://doi.org/10.1016/j.prro.2016.06.011.

— Last updated on August 5, 2022, 8:21 PM

Reviewed by 2 medical advisers
 
Anne Peled, MD
Sutter Health California Pacific Medical Center, San Francisco, CA
Stephanie Valente, DO
Cleveland Clinic Moll Cancer Center at Fairview Hospital, Cleveland, OH
Learn more about our advisory board