What is Lumpectomy Surgery?

Uses, procedure, result

Anterior view female anatomy showing a lumpectomy
Lauren Shavell / Design Pics / Getty Images

A lumpectomy is the surgical removal of a small area of breast tissue that is cancerous or suspected of being cancerous. It's sometimes referred to as breast conservation surgery or a partial mastectomy.

Lumpectomies are an option for some, but not all, cases of breast cancer, depending on many factors. Also, follow-up care differs considerably depending on whether you have a lumpectomy or mastectomy (total removal of one or both breasts.)

Purpose of Procedure

This surgery is typically reserved for women who have a single, relatively small area of tissue that must be removed. Women with a large mass may need to have significantly more breast tissue removed, which often requires a more aggressive approach such as a mastectomy.

While a lumpectomy is less disfiguring than a mastectomy and typically does not require reconstructive plastic surgery afterward, it can cause significant changes in the appearance of the breast if a large amount of tissue is taken. In addition to the scar or scars left by surgery, there may be a visible change in skin texture over the site. It may also be obvious that tissue is lacking in the area, even after the skin heals.

Lumpectomy vs Excisional Biopsy

Please note that excisional biopsy and lumpectomy are different. Lumpectomy is performed after breast cancer is diagnosed and the mission is to remove all of the tumor plus a healthy margin of tissue around it. An excisional biopsy is a diagnostic procedure, not a surgical treatment.

Lumpectomy surgery is typically performed by a surgical oncologist, a doctor who specializes in cancer surgery. It can be performed on an inpatient or outpatient basis.

Risks and Contraindications

All surgery carries a certain amount of risks. Risk of a lumpectomy include:

  • Bruising
  • Pain and tenderness
  • Infection
  • Swelling
  • Formation of hard scar tissue
  • Loss of sensation in part of the breast, which may return to some extent

In most cases, you start to see an improvement a few days after surgery. Some side effects, such as firmness and swelling, may linger for a few months. If you think you're experiencing abnormal side effects, intensities, or durations, ask your doctor about it.

Risks associated with any surgery include:

  • Excessive bleeding during or after surgery
  • Problems with wound healing
  • Breathing and heart problems due to general anesthesia (which is not always used for lumpectomy)
  • In extremely rare cases, death from general anesthesia
  • Lymphedema (when lymph fluid doesn't drain properly from the arm)

Certain people should not have a lumpectomy. This procedure is contraindicated (considered not a valid option) for people who have:

  • Have a large tumor or multiple tumors that would result in removing more than 30 percent of the breast tissue
  • Diffuse microcalcifications
  • Persistent positive margins after previous surgeries
  • Scleroderma
  • Lupus erythematosus

Additionally, lumpectomy should only be performed after a needle biopsy has confirmed the presence of breast cancer.

Some contraindications are related to the need for radiation therapy after lumpectomy, which helps ensure the cancerous cells are all gone. These include:

  • Prior chest-wall radiotherapy
  • Psoriasis
  • Sarcoidosis
  • Pregnancy, until the third trimester so that radiation can begin after childbirth

If you have any questions or concerns about the risks of a lumpectomy or whether it's the right surgery for you, be sure to address them with your doctor.

Before the Procedure

Your surgeon may want to check your lymph nodes during the lumpectomy. In that case, you'll need to have lymphoscintigraphy in preparation for a sentinel lymph node biopsy.

Talk to your doctor(s) about any medications and dietary supplements you take well before your surgery date. You may need to avoid some of them for a week before surgery, especially if they can increase bleeding. Some common, over-the-counter products can have this effect, including aspirin, Advil (ibuprofen), fish oil, and vitamin E. If you don't discontinue these when you should, your surgery may be delayed.

The facility where you're having a lumpectomy may offer you a pre-operative appointment. These are helpful for getting the paperwork out of the way, making sure you know where to go, and giving you an opportunity to ask questions.

If possible, bring along the person who will drive you to and from your surgery, as they may have questions, as well. Be sure to read consent forms before you sign them so you don't run into surprises later.

If you don't have a pre-op appointment, these things will all be taken care of when you arrive for your lumpectomy. You should feel free to call ahead with questions you want answers to before your surgery.

Timing

You'll likely be asked to arrive at the facility a couple of hours before your procedure is scheduled. The surgery itself should last somewhere between 15 and 40 minutes.

If you're having an out-patient surgery, you may be in recovery for a few hours before being discharged and sent home.

Location

Lumpectomies are generally performed in hospitals or surgery centers. They're not done in doctor's offices.

What to Wear

You will be in a surgical gown for the procedure.

The clothes you choose to wear home from your surgery should be carefully considered. You'll likely be advised to wear a soft but supportive bra, such as a sports bra. An underwire may not feel good.

You shouldn't raise your arms above your head after the surgery, so a button-down shirt is a must.

Food and Drink

You'll need to avoid food and drink for 8 to 12 hours before surgery. Ask ahead of time about any medications that you didn't have to stop before surgery and whether you can wash them down with a small amount of water.

Cost and Health Insurance

You'll want to discuss the cost of your surgery and how it'll be covered well ahead of time to avoid surprises the day-of or after your surgery.

Check with your insurance company to see what, if any, charges you'll face and when they'll be due. Also check on whether your policy covers your surgeon, anesthesiologist, the facility, and the tests that will be run on your tumor after it's removed.

If you'll owe a co-pay, expect to pay it before surgery unless you're told otherwise.

What to Bring

When you arrive for either the pre-op appointment or surgery, make sure you have your insurance card and identification, a way to pay your co-pay, and any papers your doctor may have given you. Also, bring a list of your current medications and your medical history. Let them know about any relevant allergies (medications, latex, adhesive, etc.) that you may have. If you're staying overnight, be sure they know about any food allergies, as well.

You may want to bring a book or electronic device to occupy your time before the surgery. If you'll be staying overnight, you'll need things like a toothbrush, a change of clothes, and anything you want to make yourself more comfortable.

Other Considerations

It'll probably be harder for you to manage post-surgical concerns after the surgery, so make sure you've had conversations about or made arrangement for things like:

  • Who's giving you a ride home, especially if you're having a general anesthetic and/or having out-patient surgery
  • What symptoms you should expect after surgery
  • What medications you'll be prescribed
  • Who you should call if you have problems after you get home

Anyone helping care for you after surgery should have this information, too.

Breast Cancer Doctor Discussion Guide

Get our printable guide for your next doctor's appointment to help you ask the right questions.

Doctor Discussion Guide Woman

During the Procedure

When you arrive for surgery, you will check in and begin preparations. Try to be early enough to take care of paperwork and co-pays before the scheduled time for your procedure. The facility will usually tell you how early they'd like you to be.

Pre-Surgery

Once you're all checked in, you'll change into a hospital gown and your clothes will be put in a safe place. A nurse will take your vital signs and ask some questions. Your breast may be marked to make sure the surgery is performed on the correct one and possibly to indicate where the incision should start, as well.

A few members of the surgical team will come to talk to you, including your surgeon and the anesthesiologist. They'll talk to you about the surgery, what anesthesia you'll have, and possibly give you medications to prevent nausea. You'll have an ​intravenous line (IV) inserted into your hand, through which you'll get fluids, anesthesia, and possibly other medications.

Throughout the Surgery

Most lumpectomies are performed while you're under general anesthesia. Once you're asleep, the surgeon will make the incision using a special heated scalpel that cauterizes your tissue, which helps prevent bleeding. The incision typically follows the natural contour of your breast, which allows it to heal properly.

Once the skin is opened and the surgeon identifies the tissue that's to be removed, they will inspect the mass to determine what type of tissue it is made of.

In some cases, the mass may actually be a cyst, which is a small fluid-filled sac. If so, the fluid will be drained and saved for later analysis.

In most cases, though, the lump of tissue is not a cyst and it'll be removed from your breast. Along with the suspected cancerous tissue, the area around the mass, which is called the margin, will also be removed. This is done for safety, in case cancer cells have moved into that area.

All of the tissue is saved for analysis later by a pathologist. The surgeon will also inspect the area to see if any additional structures of the body are affected by the lump, such as the muscle underlying the breast.

The surgeon will then inspect the remaining breast tissue for any signs of cancer. If there is no indication of further problematic tissue, the incision can be closed with sutures (stitches) and bandaged.

In some cases, the surgeon will also remove lymph nodes or take samples of them to determine whether cancer has spread. This requires a separate incision under the arm. The surgeon may sample several lymph nodes or remove as many as 15 or 20, depending on the situation. A drain will be put in to remove excess fluids and will then be removed after surgery.

Post-Surgery

You'll be moved to a recovery room, where you'll be monitored until you come out of anesthesia. If you're going home that day, you'll be given follow-up instructions and then, as long as no complications arise, you can go home.

If you're staying overnight, you'll then be moved to your hospital room.

After the Procedure

Dissolvable sutures may be slowly absorbed into the body over time, rather than removed. Standard sutures will be removed by the surgeon during an office visit, usually within two weeks of the surgery.

After a typical lumpectomy, removing a mass less than 5 centimeters in size, the recovery typically takes three to four weeks. If the procedure requires the removal of more tissue, the recovery can take as long as six weeks.

Managing Recovery

The first two to three days will likely be the most painful, with the pain easing somewhat each day thereafter. Be certain that you take care of your incision as directed.

Lifting is discouraged during the weeks following recovery, as is any activity that requires bouncing or raising your arms over your head, as these activities can strain the incision and cause increased pain.

You may be instructed or advised to wear a sports bra continuously for the first week or two, as it'll decrease breast movement, prevent pain, and support the incision.

Take pain medication as directed. If your pain isn't well managed, call your doctor to see what else you can do. Keep bandages dry and follow instructions regarding a surgical drain, if you have one.

Follow-Up

Be sure to keep your follow-up doctor's appointment and don't resume exercise until you're given the go ahead.

Once tests on your tumor are completed, you'll receive the pathology report. This contains critical information for determining your future treatments. For example, the margin may contain cancer cells, which means the surgeon needs to remove more tissue to lower the risk of recurrence

If the lump is examined and found to be cancerous, radiation treatments are recommended to treat any cancerous areas that may not have been located during the surgery.

A Word From Verywell

Being a candidate for a lumpectomy is a good sign—it means that even if you do have breast cancer, it's most likely contained to a small area. You'll know a lot more after the mass is removed and tested, and knowledge is power when it comes to selecting the right course of treatment to help put cancer behind you.

Was this page helpful?

Article Sources