Breast Cancer: Lumpectomy and Partial Mastectomy

Lumpectomy and partial mastectomy are breast-conserving operations in which the surgeon removes the tumor together with some normal breast tissue surrounding it. Breast-conserving procedures can often be done with local anesthesia and sedation or under general anesthesia (being put to sleep) on an outpatient basis.

Women who have this surgery usually:

• Have a single breast cancer less than 5 cm in diameter
• Have enough tissue so that removing surrounding tissue would not leave a misshapen breast
• Are medically able to undergo surgery and follow-up radiation therapy

Lumpectomy followed by radiation therapy is often considered the standard therapy for women who meet these criteria. Large studies have shown similar survival rates for both breast conservation with radiation and removal of the whole breast, but a lumpectomy gives a better cosmetic result.

Women who aren't candidates for lumpectomy plus radiation include those who:

• Have had radiation to the same breast for an earlier breast cancer
• Are pregnant and should avoid radiation
• Have multiple tumors in the breast

The Surgical Procedure

A lumpectomy is done under local or general anesthesia and usually takes one to two hours. Small metallic clips may be placed inside the breast to mark the area for the radiotherapist to treat. Lymph nodes are often examined at the same time as the breast tissue is removed, either by extending the incision to the armpit or by a separate small incision under the arm. Often, a blue dye or a small amount of radioactive material will be injected around the nipple area. These markers are taken up by the lymph nodes and help to identify which lymph nodes to remove (sentinel lymph node biopsy). The tissue that is removed from the breast is sent to the pathology laboratory where tests are done to identify the type of tumor, whether lymph nodes are involved by tumor, and to assess the tumor for hormone sensitivity (estrogen and progesterone receptors). In addition, other specialized tests that determine prognosis and treatment, such as HER2 testing and oncotyping, may be performed. It may take several days to identify the type of tumor and receive the results of the specialized tests.

Before surgery, print out these Questions to Ask so you can better understand your care.

Also before surgery, your doctor should provide:

• Specific instructions to follow in the days before surgery.
• An overview of the surgical procedure.
• Information about recovery and follow-up care.

After surgery, watch for complications such as infection or lymphedema (swelling in your arm or hand). Call your doctor immediately if you see signs of swelling, a buildup of fluid, redness, or other symptoms of infection.

Reviewed by the doctors at The Cleveland Clinic Taussig Cancer Center.