Lumpectomy

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	Lumpectomy and lymph node removal
	Finding the sentinel lymph node

When you choose lumpectomy, you're choosing a two-part process. The first part is surgery to remove the cancer and to see if the cancer has spread into nearby lymph nodes. The second part involves radiation treatment.

• Part I: Surgery. Lumpectomy (breast-sparing or breast-conserving surgery, sometimes called BCS) removes the cancerous tissue along with some surrounding healthy tissue to increase the likelihood of removing all cancer cells. Unlike mastectomy, lumpectomy leaves most of the breast intact. The lymph nodes under the arm still need to be examined, though. This can be done by axillary lymph node dissection or, more commonly, by sentinel lymph node biopsy.
• Part II: Radiation treatment. In general, if you choose to have a lumpectomy, you'll undergo radiation treatment at some point after the operation. Radiation treatments usually begin three to four weeks after surgery, unless you receive chemotherapy. In that case, radiation is usually administered after completion of the chemotherapy. Treatment with lumpectomy and radiation offers the same chance of survival as does mastectomy.

Unfavorable situations for lumpectomy
In some situations, lumpectomy may not be a good choice. Your doctor can determine if this is the case based on your medical history, examination and breast-imaging reports.

In mastectomy, your entire breast is removed. Mastectomy typically is a better choice than a lumpectomy followed by radiation in these instances:

• You're in the first or second trimester of pregnancy, when radiation creates an unacceptable risk to your unborn child.
• You have two or more tumors in separate areas of the breast (multicentric disease).
• You have widespread malignant-appearing microcalcifications throughout the breast.
• You've previously had radiation treatment to the breast region.
• You have a strong family history of breast cancer.
• You carry a gene mutation that carries a high risk of developing another cancer.

Even if lumpectomy isn't strictly advisable in your situation, you might choose mastectomy over lumpectomy if:

• You have a large tumor relative to the overall size of your breast. You may not have enough healthy tissue left after lumpectomy to achieve an acceptable cosmetic result.
• You have a history of connective tissue disease, such as scleroderma or rheumatoid arthritis, and may not tolerate the side effects of radiation, particularly to the skin.
• The tumor is located beneath the nipple and may involve the nipple, making it more difficult to preserve the nipple and areola.
• You live a long distance from a radiation facility and being there every day for six weeks would be very difficult.

How do you prepare for lumpectomy?
Lumpectomy is performed under local or regional (epidural) anesthesia, in which case only the surgical site is numbed, or under general anesthesia, which affects your entire body and renders you temporarily unconscious. Because the effects of anesthetics and pain medication can take several hours to wear off, be sure to make advance arrangements for transportation home from the hospital or clinic.

Before the surgery, your doctor will meet with you to discuss your medical history and any questions or concerns you may have about the operation. Certain circumstances can complicate the procedure, so before the surgery, tell your doctor if:

• You're pregnant — this may preclude treatment with general anesthesia or certain medications
• You're allergic to any medications, including anesthetics
• You or any family members have had adverse reactions to anesthetics in the past
• You're on medication, even aspirin, or you've been taking herbal supplements

To make sure that your stomach is empty of any food, refrain from eating for six to 12 hours before your surgery. You may drink clear liquids, such as water, apple juice, tea or coffee without cream or sugar, before coming to the hospital.

The procedure is often performed as outpatient surgery. Most women don't need to spend the night in the hospital unless they're also having lymph nodes removed.

How is a lumpectomy done?
Lumpectomy is considered breast-conserving surgery because it aims to save as much of your breast as possible. Lumpectomy usually takes less than two hours.

In the operating room, your surgeon makes an incision large enough to remove both the tumor and a margin of healthy tissue surrounding the tumor. The ideal size of the margin is about 1 centimeter, or less than half an inch. The margin is taken to help ensure that all cancer cells are removed.

Your surgeon will also sample the lymph nodes under your armpit to check for the spread of cancer. One way to do this is with an axillary lymph node dissection. However, surgeons are now more commonly performing a procedure called sentinel lymph node biopsy to determine if cancer has spread to the lymphatic system. The sentinel lymph node is the first lymph node to which a tumor drains. By finding the sentinel node before surgery, doctors can remove the node for evaluation during surgery.

If the sentinel node is free of cancer, the cancer isn't likely to have spread, and further removal of lymph nodes is typically unnecessary. If the sentinel lymph node is involved, then your surgeon will remove additional lymph nodes through a second incision in your armpit. If your surgeon doesn't routinely perform sentinel lymph node biopsies, then he or she will remove several lymph nodes through an incision in your armpit. The presence or absence of cancer in the lymph glands of your armpit is also important for determining treatment after the operation.

All of your incisions will be closed with sutures (stitches), which either dissolve or are removed later by a member of your health care team. Thin adhesive strips may be placed across your incisions to help hold them together while the incisions heal. The strips normally loosen and come off on their own in a few weeks.

After the procedure
Excessive pain after lumpectomy is unlikely. However, you may experience a feeling of tightness or numbness, particularly under the arm. Some of this numbness gradually fades as nerve cells regenerate. The numbness can last anywhere from a few months to a few years. For some women, a mild degree of numbness can persist the rest of their lives. Having a sentinel lymph node biopsy usually results in less numbness than does a complete axillary node dissection.

Expect some fatigue after surgery. Facing cancer surgery is an emotionally draining experience, and surgery is physically taxing as well. Plan a lighter schedule, with the possibility of daily naps, for the weeks after your surgery.

You'll likely experience a loss of sensation in part of your breast after lumpectomy, but this is usually temporary.

Radiation therapy follow-up
After you've had several weeks to heal from your lumpectomy, you'll begin the second part of treatment — radiation. This usually begins three to four weeks after the lumpectomy, when the surgical scar has healed. If you chose chemotherapy, your radiation treatments typically begin after you complete the chemotherapy.

Radiation can be administered by X-ray machine (external beam) or through tiny tubes of radioactive material temporarily implanted in your breast.