Breast lump removal

Definition

Breast lump removal is surgery to remove a lump in the breast and some surrounding tissue from the breast.

Alternative Names

Lumpectomy; Wide local excision; Excisional biopsy; Limited breast surgery; Segmental mastectomy: Breast conservation therapy or surgery; Tylectomy; Breast sparing surgery; Partial mastectomy; Segmental breast excision

Description

Breast lump removal is usually done in an outpatient clinic. You will be given general anesthesia (asleep, but pain free) or local anesthesia (awake, but sedated and pain free). The procedure takes about 1 to 2 hours.

The surgeon makes a small incision (cut) on your breast. The surgeon then removes some of the lump and breast tissue around it.

• If the lump is not breast cancer, your surgeon will not remove very much breast tissue from around the lump.
• If you have breast cancer, the amount of breast tissue around the lump the surgeon removes may depend on what type of breast cancer you have.
• The surgeon will close the skin with stitches. These may dissolve or need to be removed later. A drain tube may be placed to remove excess fluid.

Your doctor will send the lump to a laboratory for testing.

If you have a lump with breast cancer in it, your surgeon will also remove lymph nodes in your axilla (armpit). This will be done through another surgical cut underneath your arm. The lymph nodes will also be tested for cancer. This is called staging. Staging helps your doctor plan your treatment.

Why the Procedure Is Performed

Lumpectomy is performed to either diagnose or treat an abnormal spot in the breast. Before a lumpectomy, your doctor will have done a needle biopsy and imaging tests (such as mammography) to see if you have breast cancer.

If a needle biopsy showed that you have breast cancer, your doctor will have you take more tests to see if the cancer has spread.

• Treatment depends on the type of breast cancer, if the cancer has spread, and to where, your age, whether you have reached menopause, and your overall health.
• For some breast cancer, mastectomy may be better treatment. For other breast cancer, lumpectomy (breast conservation therapy) may treat your cancer. Your doctor will help you decide what treatment is best for you.

Other reasons to perform a lumpectomy are:

• If you have fibroadenoma or other benign tumors of the breast.
• If you have a fluid-filled lump (cyst). Your doctor will first use a needle and syringe to drain fluid from the cyst. If the fluid is clear or green, is not bloody, and the cyst disappears when drained, nothing further needs to be done. If the fluid is bloody, your doctor will send it to a laboratory for testing. If you still have a lump after your doctor drains the cyst, you will need surgery to remove it. You will also need surgery if the cyst disappears after it is drained but then later returns.

Risks

Risks for any surgery are:

• Bleeding
• Infection
• Reactions to medications

Risks for this procedure are:

• Since a lumpectomy removes part of the breast, the appearance of your breast may change. After surgery, you may notice dimpling, a scar, or a difference in shape between the two breasts.
• Some microscopic pieces of the lump may be left behind after surgery. If this happens, they will need to be removed in another operation.
• You may also have numbness in the breast area.

Before the Procedure

Always tell your doctor or nurse:

• If you could be pregnant
• What drugs you are taking, even drugs or herbs you bought without a prescription

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
• Ask your doctor which drugs you should still take on the day of the surgery.
• Always try to stop smoking. Your doctor or nurse can help.

On the day of the surgery:

• You will be asked not to drink or eat anything after midnight the night before the surgery.
• Take the drugs your doctor told you to take with a small sip of water.
• Your doctor or nurse will tell you when to arrive for the procedure.

After the Procedure

The recovery period is very short for a simple lumpectomy. You should have little pain. If you do feel pain, you can take pain medicine, such as acetaminophen (Tylenol). Most women can resume their usual activities in a week or so. The skin should heal in about a month.

You will need to take care of the incision area. Change dressings as your doctor or nurse tells you to. Watch for signs of infection when you get home (such as redness and swelling).

You may need to empty a fluid drain a few times a day for 1 to 2 weeks. Your doctor will remove the drain later.

Avoid heavy lifting or jogging for 1 to 2 weeks. Your doctor will show you special exercises to prevent arm stiffness and talk to you about clothing and bra options, if necessary.

You may notice slight scarring.

If cancer is found, you will need to schedule follow-up treatment with your doctor.

Outlook (Prognosis)

The outcome of a lumpectomy depends on the type of lump your doctor finds, and whether or not it is cancerous.

A lumpectomy for breast cancer is often followed by radiation therapy, chemotherapy, or hormone therapy. This usually results in the same long-term survival as a mastectomy, depending on the type and how much breast cancer you have.

Women usually do not need breast reconstruction after lumpectomy.

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References

Iglehart JK, Smith BL. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery, 18th ed. St. Louis, Mo: WB Saunders; 2008:chap 34.

Khatcheressian JL, Wolff AC, Smith TJ, Grunfeld E, Muss HB, Vogel VG, et al. American Society of Clinical Oncology 2006 update of the breast cancer follow-up and management guidelines in the adjuvant setting. J Clin Oncol. 2006;24(31):5091-5097.

Abeloff MD, Wolff AC, Weber BL, Zaks TZ, Sacchini V, McCormick B. Cancer of the breast. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKena WG, eds. Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 95.