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Locating the area to be removed
Your lumpectomy procedure begins with locating the area of your breast that contains the abnormality. If your breast abnormality was detected on a mammogram and confirmed with a biopsy, your radiologist may have placed a tiny marker or clip in your breast during the biopsy. If this is the case, a thin wire may be inserted in your breast and passed down to the marker or clip. Your surgeon can use the wire as a guide to the precise area that needs to be removed during surgery. If you have a lump or mass in your breast that can be easily felt through the skin, the wire procedure isn't necessary because the surgeon can more easily find the abnormal area to be removed.
Preparing for lymph node removal
Lymph nodes are often removed during surgery to determine whether cancer has spread beyond the breast. In one lymph node procedure called an axillary node dissection, the surgeon removes a number of nodes from your armpit on the side of the tumor. In another lymph node procedure called a sentinel lymph node biopsy, your surgeon removes only the first one or two nodes into which a tumor drains (sentinel nodes). These are then tested for cancer. If no cancer is present, no further lymph nodes need to be removed. If cancer is present, the surgeon will remove more lymph nodes in the armpit.
If you're having sentinel node biopsy, before your surgery a radioactive substance or blue dye or both will be injected into the area around the tumor or the skin above the tumor. The dye will travel to the sentinel node or nodes, allowing your doctor to see where they are and remove them during surgery.
During the procedure
A lumpectomy is usually performed using anesthesia, which will make you unaware during the procedure. Your surgeon will make an incision over the tumor or over the area that contains the wire, remove the tumor and some surrounding tissue, and send it to the lab for analysis. He or she will do the same for the sentinel lymph node or nodes if you're having a sentinel node biopsy or the axillary lymph nodes if you're having an axillary node dissection. The surgeon will then close the incisions with attention to preserving the appearance of your breast, using stitches (sutures) that will either dissolve on their own or be removed later by your doctor.
After the procedure
After your surgery, you'll be taken to a recovery room. During this time, your blood pressure, pulse and breathing will be monitored. If you've had outpatient surgery — usually lumpectomy and sentinel node biopsy — you'll be released when your condition is stable. If you've had axillary node biopsy, you may need to stay in the hospital a day or two so the medical staff can monitor your condition.
Expect to have:
- A dressing (bandage) over the surgery site
- Some pain, numbness and a pinching sensation in your underarm area
- Written instructions about post-surgical care, including caring for the incision and dressing, recognizing signs of infection
- Prescriptions for pain medication and possibly an antibiotic
- Some restrictions of activity
- A follow-up appointment with your doctor, usually seven to 14 days after surgery
- Breast cancer treatment (PDQ). National Cancer Institute. http://www.cancer.gov/cancertopics/pdq/treatment/breast/healthprofessional/AllPages. Accessed Aug. 18, 2011.
- Iglehart JD, et al. Diseases of the breast. In: Townsend CM Jr, et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 18th ed. Philadelphia, Pa.: Saunders Elsevier; 2008. http://www.mdconsult.com/das/book/body/208746819-6/0/1565/0.html. Accessed Aug. 18, 2011.
- Surgery for breast cancer. American Cancer Society. http://www.cancer.org/Cancer/BreastCancer/DetailedGuide/breast-cancer-treating-surgery. Accessed Aug. 18, 2011.
- Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 16, 2011.
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