What To Expect With Lumpectomy
If you’ve been diagnosed with breast cancer and you’re considering lumpectomy, here’s what you can expect before, during, and after the surgery.
Before lumpectomy surgery
When you arrive at the hospital on the day of surgery, you 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 prepares you for a needle localization. After injecting a numbing agent into the breast (local anesthesia), the radiologist inserts a thin wire into the area to help guide the surgeon. The wire sticks out from the breast and has to be protected and kept in position until the surgery begins. Some surgeons now use wire-free localization, which can be done a few days before surgery. The radiologist inserts a tiny seed through the skin into the area where the cancer is. Some seeds are magnetic, some are radioactive, and others are reflective and emit radar waves. On the day of the procedure, the surgeon uses a detection device to locate the seed and find the cancer.
The surgeon may mark the planned incision site on your breast — usually with a felt-tip marker.
If you are having a sentinel lymph node biopsy, your surgical team injects a blue dye underneath the nipple or near the cancer site. Sometimes the dye is combined with a radioactive or magnetic tracer. The dye travels to the sentinel lymph nodes and helps the surgeon decide which lymph nodes need to be removed. Your surgical team may wait until after you have general anesthesia to inject you with the dye.
Once you are in the anesthesia room, a nurse inserts an intravenous (IV) infusion line into your hand or arm and tapes it into place. Then, the nurse gives you relaxing medication through the IV line. Most people who have lumpectomy have general anesthesia, but some may have IV sedation and a local anesthetic to numb the area.
During lumpectomy surgery
A lumpectomy can take about 60 to 90 minutes. The procedure takes longer if you have oncoplastic lumpectomy or lymph node removal along with lumpectomy.
Surgeons usually operate with a scalpel and an electrocautery knife, called a Bovie. This is a kind of electric scalpel that uses heat to minimize and stop bleeding. Most surgeons use hidden incisions or incisions that follow the natural curve of your breast. Many surgeons place the scar along the areola (the dark skin surrounding the nipple), along the edge of the breast, in the underarm crease, or under the breast fold so it’s not obvious (called aesthetic scar placement). It’s a good idea to talk to your surgeon about scar placement before surgery so you know what to expect.
The surgeon removes the breast cancer tumor and a rim of healthy tissue around it. The surgeon also may place small clips or another type of marker to identify the original cancer site, which helps the radiation oncologist target radiation treatments.
If you need to have a sentinel lymph node biopsy or dissection, the surgeon removes up to three lymph nodes through a separate small incision under the armpit. The lymph nodes go to the pathology lab for examination to see if they have cancer in them.
In some cases, a rubber tube called a drain is 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 this fluid. Finally, your surgeon closes the incision and puts a dressing over it.
After lumpectomy surgery
When the surgery is finished, you are taken to the recovery room, where staff monitor your heart rate, body temperature, blood pressure, and pain level. Staying overnight in the hospital is not usually necessary but may be recommended in some cases. You also may need to stay overnight if you have an oncoplastic lumpectomy that involves a breast reduction or breast lift, which is more extensive surgery.
Recovery from lumpectomy usually takes a few days. If you have a more extensive procedure, recovery can take a few weeks or more. Your surgical team should give you instructions on what you can expect to do once you are home:
Take pain medication. You may receive pain medication in the recovery room, and you may very likely get a prescription from your surgeon when you leave the hospital. Some people who have lumpectomy are able to manage any discomfort with acetaminophen, ibuprofen, and ice.
Care for the bandage (dressing) covering your incision. Before surgery, your team explains how to care for your incisions and dressings. It’s a good idea to ask any questions you may have before leaving the hospital. Some surgeons prefer to remove the bandages themselves during the first follow-up visit. 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.
Care for the surgical drain. If you have a drain in your breast area or armpit, your surgical team may remove the drain before you leave the hospital. Sometimes, however, the drain remains in place until the first follow-up visit with the doctor — usually one to two weeks after surgery. If your drain has to stay in place until your first follow-up visit, you need to empty the fluid from the detachable drain bulb a few times a day. It’s important to get instructions on caring for the drain from your surgeon before leaving the hospital.
Keep an eye on your stitches. Most surgeons use stitches (sutures) that dissolve after some time, so there’s no longer any need to have them removed. It’s possible to see the end of a suture poking out of the incision like a whisker — but your surgeon can easily remove it.
Exercise your arm. There are activity recommendations and restrictions for you to follow after your surgery. Your surgeon should give you written, illustrated instructions on how to do simple after-surgery arm exercises to prevent arm and shoulder stiffness on the side where you had the lumpectomy. You can usually start the exercises the morning after surgery. Your surgeon also should let you know which exercises to avoid until your drains are removed or your incisions are more healed.
Recognize signs of infection. Your surgical team should explain what the signs of an infected incision are and when and how to contact the office.
Here are some guidelines to follow during your recovery period:
Rest. When you get home from the hospital, it’s normal to feel fatigued so it’s a good idea to get plenty of rest. If after a few days you still feel too tired to return to your regular routine, there are a number of ways you can manage fatigue.
Take pain medication as needed. It’s possible to feel a mixture of numbness and pain around the surgery area in the breast (and the armpit incision, if the surgeon removed any lymph nodes). If you feel pain, take the medication your doctor prescribed according to the instructions you received. Learn more about managing pain and armpit discomfort.
Take sponge baths if you have drains. Many people are able to shower 48 hours after surgery, as long as they keep incisions clean, dry, and covered with gauze.
Wear a good sports or support bra only if your doctor says you can. Wearing a supportive bra day and night for some time can minimize any movement that might 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. People who have oncoplastic lumpectomy surgery get a special support bra from their surgical team.
Follow the surgical team’s instructions. You can typically start any approved arm exercises the morning after surgery. It’s also important to follow the surgical team’s advice and walk around as much as possible, as long as you limit lifting, pushing, or pulling with the arm on the affected side.
As nerves regrow, you may feel an itchy or a crawling sensation, and you may be very sensitive to touch.
Acetaminophen or NSAIDs such as ibuprofen usually can help ease any pain you may feel after lumpectomy. If you need something stronger, your doctor may prescribe opioids.
Written by: Kristine Conner, contributing writer
— Last updated on August 23, 2022, 7:21 PM