Lumpectomy: What to Expect
If you’re having or considering lumpectomy to remove the breast cancer, here’s what you can expect before, during, and after the surgery.
Before lumpectomy surgery
In the hospital on the day of surgery, you’ll change into a hospital gown and wait in a pre-surgery holding area.
Before surgery, a radiologist usually locates the tumor using a mammogram or ultrasound, and then marks the tumor by placing a small chip, thin wire, or needle to help guide the surgeon.
Your surgeon or a nurse may draw markings on your breast that show where the incision will be made. Usually this is done with a felt-tip marker.
You will be taken into the anesthesia room, where a nurse will insert an intravenous infusion (IV) line into your hand or arm and tape it into place. Soon after this, you’ll be given relaxing medication through the IV line. Most people who have lumpectomy have general anesthesia, but some may have a local anesthetic to numb the surgery area.
What happens during lumpectomy surgery
The lumpectomy surgery itself should take about 15 to 40 minutes. However, if you are having oncoplastic lumpectomy, the procedure will take longer.
Your surgeon will probably operate with an electrocautery knife, a kind of electric scalpel that uses heat to minimize bleeding. Most surgeons use curved incisions (like a smile or a frown) that follow the natural curve of your breast and allow for better healing. You can ask your surgeon for aesthetic scar placement, which hides the scar by placing it along the areola (the dark skin surrounding the nipple) or under the breast fold.
The surgeon will remove the breast cancer tumor along with a rim of healthy tissue around it (called the margin). The surgeon also will place small clips to mark the original cancer site, which helps the radiation oncologist target your radiation treatments.
You also may need to have one to three underarm lymph nodes removed so they can be examined to see if the cancer has spread (called a sentinel lymph node biopsy). The surgeon will inject a radioactive liquid or blue dye into the breast and identify the first one or two lymph nodes that drain fluid from the area where the cancer was found. Those lymph nodes are removed through a small incision under the armpit and sent to the pathology lab for examination.
Sometimes, but not always, a rubber tube called a drain will be surgically inserted into your 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, your surgeon will stitch the incision closed and dress the wound.
You’ll be moved to the recovery room after lumpectomy surgery, where staff will monitor your heart rate, body temperature, and blood pressure. Staying overnight in the hospital is not usually necessary with lumpectomy, unless you have more than a few lymph nodes removed (axillary lymph node dissection). You also may need to stay overnight if you have oncoplastic lumpectomy that involves a breast reduction or breast lift, which is more extensive surgery.
As you start to feel more awake, your surgeon or nurse will give you information about
recovering at home, such as:
Taking pain medication: You may be given pain medication in the recovery room, and your surgeon will probably give you a prescription to take with you when you leave the hospital. You might want to get it filled on your way home or have a friend or family member get it filled for you as soon as you are home. You may not need the medication, but it’s good to have it on hand in case you do.
Caring for the bandage (dressing) over your incision: Ask your surgeon how to take care of the lumpectomy bandage. Sometimes, the surgeon will ask that you wait until your first follow-up visit so that he or she can remove the bandage. If you have oncoplastic lumpectomy, you can expect to have larger bandages and possibly a special support bra, depending on the extent of your surgery.
Caring for a surgical drain: If you have a drain in your breast area or armpit, the drain might be removed before you leave the hospital. Sometimes, however, a drain stays inserted until the first follow-up visit with the doctor, usually one to two weeks after surgery. If you’re going home with a drain inserted, you’ll need to empty the fluid from the detachable drain bulb a few times a day. Make sure your surgeon gives you instructions on caring for the drain before you leave the hospital.
Stitches and staples: Most surgeons use sutures (stitches) that dissolve over time, so there's no longer any need to have them removed. But occasionally, you'll see the end of the suture poking out of the incision like a whisker. If this happens, your surgeon can easily remove it. Surgical staples — another way of closing the incision — are removed during the first office visit after surgery.
Exercising your arm: Your surgeon may show you an exercise routine you can do after surgery to prevent arm and shoulder stiffness on the side where you had the lumpectomy. Usually, you will start the exercises the morning after surgery. Some exercises should be avoided until drains are removed. Ask your surgeon any questions you may have to make sure the exercise routine is right for you. Your surgeon should also give you written, illustrated instructions on how to do the exercises.
Recognizing signs of infection: Your surgeon should explain how to tell if you have an infection in your incision and when to call the office.
You’ll recover at home for a few days after lumpectomy surgery. If you had a more extensive oncoplastic lumpectomy, recovery can take a few weeks or more.
Here are some guidelines to follow for your recovery from lumpectomy surgery:
Rest. When you get home from the hospital, you might be fatigued from the experience. Allow yourself to get enough rest so that you can return to your normal routine in a few days. There are a number of ways to manage fatigue.
Take pain medication as needed. You might feel a mixture of numbness and pain around the surgery area in the breast (and the armpit incision, if you had lymph nodes removed). If you feel the need, take pain medication according to your doctor’s instructions. Learn more about managing pain and armpit discomfort.
Take sponge baths until your doctor has removed your drains and sutures. You can take your first shower when your drains and any staples or sutures have been removed. A sponge bath can refresh you until showers or baths are approved by your doctor.
Wear a good sports or support bra (but get your doctor’s OK first). You’ll want a supportive bra to wear both day and night for a while to minimize any movement that could cause pain. If you have larger breasts, you may find it more comfortable to sleep on the side that has not been operated on, with your healing breast supported by a pillow in front of you. If you had an oncoplastic lumpectomy, ask your surgeon about when it’s OK to start wearing a bra again.
Begin doing arm exercises. The morning after surgery, begin doing arm exercises if your surgeon has advised you to do so.
Weeks and months after lumpectomy
As nerves regrow, you may feel a weird crawly sensation, you may itch, and you may be very sensitive to touch.
Acetaminophen or NSAIDs such as ibuprofen usually can address the pain related to this type of nerve injury. If needed, opioids also can be used to treat this type of pain.
Your discomfort may go away by itself, or it may persist over time — a condition called post-mastectomy pain syndrome.
If your discomfort persists, talk to your doctor. Other medications, such as antidepressants and topical capsaicin, may be helpful. Physical therapy and therapeutic massage also may provide some relief.
— Last updated on February 10, 2022, 1:16 AM