Breast cancer: Lumpectomy and partial mastectomy
Lumpectomy and partial mastectomy are breast-conserving operations in which the surgeon removes the tumour together with some normal breast tissue surrounding it. Breast-conserving procedures can often be done with local anaesthetic and sedation or under general anesthesia (being put to sleep) as a day case.
Women who have this surgery usually:
- Have a single breast cancer less than five 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 radiotherapy
Lumpectomy followed by radiotherapy is often considered the standard therapy for women who meet these criteria. Large studies have shown similar survival rates for both breast conservation with radiotherapy and removal of the whole breast, but a lumpectomy gives a better cosmetic result.
Women who aren't candidates for lumpectomy plus radiotherapy include those who:
- Have had radiotherapy to the same breast for an earlier breast cancer
- Are pregnant and should avoid radiotherapy
- Have multiple tumours in the breast
The surgical procedure
A lumpectomy is done under local or general anaesthetic 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 tumour, whether lymph nodes are involved by tumour, and to assess the tumour for hormone sensitivity (oestrogen and progesterone receptors). In addition, other specialised tests that determine prognosis and treatment may be performed. It may take several days to identify the type of tumour and receive the results of the specialised tests.
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 lymphoedema (swelling in your arm or hand). Seek medical advice immediately if you see signs of swelling, a build-up of fluid, redness, or other symptoms of infection.
Complications of surgery
Mastectomy, lumpectomy and axillary node dissection are fairly safe operations, but every operation has the risk of complications.
Patients should seek medical advice immediately if they see any signs of:
- Infection including redness and swelling of the incision with pus or foul-smelling drainage, perhaps with fever. Antibiotics can be used to treat post-surgical infections.
- Lymphoedema, the swelling of the arm and/or hand on the side of the surgery due to the removal of the lymph nodes under the arm. Lymphoedema often goes away on its own, but sometimes requires treatment.
Treatment is usually provided by physiotherapists or occupational therapists and includes:
- Manually draining the fluid.
- Caring for the skin.
- Exercising the arm.
- Wearing compression bandages to keep the swelling from recurring.
- Seroma, which is accumulation of fluid in the location of the surgery. While most of the time the fluid is absorbed by the body, the area can be drained using a needle if it does not go away.
- Other complications may include stiffness of the shoulder and possible numbness or altered sensation in the upper arm or armpit.
Before surgery your doctor should provide you with information about recovery and follow-up care.