Lumpectomy Surgery Preparation Instructions, and Recovery Time

Picture of a breast with a lump.

• Lumpectomy is a surgical procedure that involves removing a suspected malignant (cancerous) tumor or other abnormal tissue and a small portion of the surrounding breast tissue.
• This tissue is then tested to determine if it contains cancerous cells.
• A number of lymph nodes may also be removed to test them for cancerous cells (sentinel lymph node biopsy or axillary dissection).
• If cancerous cells are discovered in the tissue sample or nodes, additional surgery or treatment may be necessary.
• Women who undergo a lumpectomy normally receive radiation therapy (RT) for about six weeks following the procedure to kill any cancer cells that may have been missed with the removal of the tumor.
• Lumpectomy is also referred to as
  • partial mastectomy,
  • wedge resection,
  • breast-sparing therapy,
  • breast-conserving therapy,
  • breast-conserving surgery,
  • excision biopsy is when a fibradenoma of the breast is removed.
  • tylectomy,
  • segmental excision, and
  • quadrantectomy.
• Lumpectomy is used to treat both invasive cancers of the breast (invasive ductal carcinoma or invasive lobular carcinoma) as well as ductal carcinoma in situ (DCIS).
• A few decades ago, the standard breast cancer surgery was radical mastectomy, which involves the complete removal of the breast, muscles from the chest wall and all the lymph nodes in the armpit. Breast-conserving surgery has replaced radical mastectomy as the preferred surgical treatment because lumpectomy is designed to leave the natural appearance and cosmetic quality of the breast mostly intact while removing the malignancy and a small margin of normal breast tissue. In addition, studies have shown that lumpectomy with radiation treatment is as effective as mastectomy in treating breast cancer.
• The size and location of the lump determine how much of the breast is removed during a lumpectomy. A quadrantectomy, for example, involves removing a quarter of the breast. Before surgery, a woman should discuss with her doctor how much of the breast will be involved so that she can know what to expect.
• The size of the cancer in relation to the size of the breast is the main factor that a woman's doctor considers to determine if a lumpectomy is an appropriate treatment. Additionally, some of the features of the cancer (if it is confined to one area of the breast and does not involve the skin or chest wall) help the doctor determine if lumpectomy is appropriate. Most women who are diagnosed with breast cancer, especially those who are diagnosed early, are considered good candidates for lumpectomy. However, under some circumstances, lumpectomy is not a recommended surgery for some women. These factors include the following:
• Multiple cancers in separate locations of the same breast: This means that the potentially malignant tissue cannot all be removed from a single location, meaning that the breast may become drastically disfigured as a result of lumpectomy.
• Prior lumpectomy with radiation: Women who have had a lumpectomy with radiation therapy to remove cancer cannot have more radiation; therefore, they usually need a mastectomy if they experience cancer again in the same breast.
• Extensive cancer: Since a lumpectomy removes a specific area with malignancy, this cancer treatment option would be inappropriate if the cancer has spread to other locations.
• Problematic tumors: A tumor that is rapidly growing or has attached itself to a nearby structure, such as the chest wall or skin, may require surgery that is more extensive to remove the tumor.
• Pregnancy: Radiation therapy, which usually follows the lumpectomy, can damage the woman's fetus.
• Large tumors: Lumpectomy to remove a tumor that is larger than 5 cm in diameter may drastically disfigure the breast. However, in some cases, the size of the tumor may be able to be reduced with chemotherapy, or endocrine therapy, to a size that is more manageable with lumpectomy. Small breasts, especially those that contain large lumps, may also be drastically disfigured after lumpectomy.
• Preexisting conditions that make radiation treatment more risky than usual: Radiation treatment may scar or damage connective tissue in women with collagen vascular diseases, such as scleroderma or lupus erythematosus.
• Prior radiation to the chest area, for instance, to treat Hodgkin's disease.
• Lumpectomy vs. mastectomy, some women may prefer the idea of a mastectomy to lumpectomy in order to feel more confident that they will not develop breast cancer again. Other women may not feel comfortable with radiation therapy or be able to commit to a series of radiation treatments, which may involve an unacceptable time commitment or extensive travel. In most situations, though, women can safely choose between lumpectomy and mastectomy.

Types of Lumpectomy Surgery.

Sentinel node biopsy: Sentinel node biopsy is a procedure in which the surgeon removes one to five (or more, in some cases) sentinel lymph nodes from the underarm area (axilla).

• The sentinel lymph node is the first location that cancer cells are likely to spread. If cancer cells are not found in the sentinel node, the other lymph nodes are likely to be cancer free as well.
• Sentinel node biopsy is a popular alternative to axillary lymph node sampling or axillary lymph node dissection, which involve removing more lymph nodes than sentinel node biopsy.
• In some cases, removing more than a few lymph nodes in a lymph node dissection can lead to complications in the arm such as fluid buildup (lymphedema) or decreased sensation.
• Sentinel node biopsy allows for limited damage to the nerves and lymphatic system.

Axillary lymph node sampling or dissection: Axillary lymph node surgical procedure involves removal of the lymph nodes en bloc, which are then tested for cancer cells.

• Because so many nodes are removed, a drain is placed to prevent lymph fluid from collecting.
• The drain is usually removed in 5-10 days.
• Axillary lymph node dissection is associated with several complications and side effects, which include
• long-term pain,
• limited shoulder motion,
• lymphedema,
• numbness, and
• an increased risk of infection.

However, most doctors believe that if you have cancer in some lymph nodes (for instance the sentinel nodes) that it helps determine further treatment to know how many more nodes are cancerous. Axillary node dissections are usually done now only in the situation where one or more lymph nodes contain cancer as shown during a lymph node biopsy.

What Procedures and Tests Are Needed Before Lumpectomy Surgery?

• Prior to lumpectomy, the doctor usually examines the patient and performs a mammogram, which is an X-ray film of the breast's soft tissue.
• The doctor usually performs a fine-needle biopsy of the breast and takes blood and urine samples for testing.
• If the breat tumor is not palpable (cannot be located by touch), the doctor performs a wire-localization procedure, which involves a fine wire, or similar tool, along with an X-ray film or ultrasound to confirm the tumor's location.
• A breast MRI scan may also be performed, prior to lumpectomy, to determine whether there is another disease in the same or opposite breast, that may prevent a lumpectomy from being performed.

How Do You Prepare for Lumpectomy Surgery?

• The preparations for a lumpectomy are routine for a typical surgery.
• The doctor may ask the woman about any medications or supplements she may be taking.
• The doctor usually advises the woman not to eat or to drink anything for at least 8-12 hours before the surgery.
• The doctor usually discusses what to expect during and after surgery, which may include what
  • sensations she may feel during the surgery,
  • type of anesthesia will be used, and
  • to expect following lumprocedure.
• Immediately before the procedure, the woman receives either (1) a local anesthetic (medication that numbs only the breast and nearby tissues) and sedation or (2) general anesthesia (medication that induces unconsciousness).
• Which type of anesthesia the woman receives usually depends on how extensive the doctor expects the surgery to be.
• Women receive general anesthesia, a medication will be given to you through an IV  line that induces unconciousness (you will be sleeping), and to provide fluids and medication. A tube is placed in the throat that supplies oxygen and gasses for sedation.

First, the doctor cleans the involved breast, chest, and upper arm. The surgeon then makes an incision over the targeted malignancy or around the areola if the tumor is accessible from that site, and cuts out the tumor, along with a small layer of tissue surrounding the tumor. The goal of the surgery is to remove the tumor and marginal tissue while damaging the breast as little as possible. However, the surgeon needs to remove enough testable tissue to determine if the cancer is limited to the tumor itself or if the cancer has spread.

The surgeon may make a separate incision near the underarm to sample or to remove axillary lymph nodes, which are then tested for cancerous cells. The findings of these tests help the doctor determine if the cancer has spread from the breast to other parts of the body. The following are types of surgery that may be used to sample or remove axillary lymph nodes:

Sentinel node biopsy: This procedure involves surgically removing one to five (or more, in some cases) sentinel lymph nodes from the underarm area (axilla). The sentinel lymph node is the first location that cancer cells are likely to spread. If cancer cells are not found in the sentinel node, the other lymph nodes are likely to be cancer free as well. This is a popular alternative to axillary lymph node sampling or axillary lymph node dissection, which involve removing more lymph nodes than sentinel node biopsy. In some cases, removing more than a few lymph nodes in a lymph node dissection can lead to complications in the arm such as fluid buildup (lymphedema) or decreased sensation. Sentinel node biopsy allows for limited damage to the nerves and lymphatic system.

Axillary lymph node sampling or dissection: This surgical procedure involves removal of the lymph nodes en bloc, which are then tested for cancer cells. Because so many nodes are removed, a drain is placed to prevent lymph fluid from collecting. The drain is usually removed in 5-10 days. Axillary lymph node dissection is associated with several complications and side effects, which include long-term pain, limited shoulder motion, lymphedema, numbness, and an increased risk of infection. However, most doctors believe that if you have cancer in some lymph nodes (for instance the sentinel nodes) that it helps determine further treatment to know how many more nodes are cancerous. Axillary node dissections are usually done now only in the situation where one or more lymph nodes contain cancer as shown during a lymph node biopsy.

The surgeon then stops the bleeding and irrigates the wound. A drainage tube may be inserted during the surgery and removed later. The wound is usually closed with stitches that will eventually dissolve. Bandages are applied to the site of the surgery.

The entire procedure typically takes one to two hours.

After a lumpectomy, you are moved to a surgery recovery room for a short time until you wake up and are stable. Most women go home with home-care instructions the same day, but a few women have to stay in the hospital for one to two days (especially after axillary node dissection).

• Preventing infections will usually be emphasised your doctor's home care instructions.
• Postsurgical factors after lumpectomy surgery depend on the size and location of the tumor removed, the general health of the woman, and the preferences of the patient and her doctor.
• Pain relief can be treated by placing a bag of ice on top of the bandages over the incision for the first 24 hours.
• If a quarter or more of your breast was removed, you should expect a slower healing process.
• Most women can expect to resume their normal activities after one to two days.
• Women who undergo a sentinel lymph node biopsy or axillary dissection at the same time as lumpectomy can expect to return to normal activities by about two weeks after surgery. In the meantime, they usually take prescribed medications that help control  pain.
• Major soreness and pain from lumpectomy procedure typically stops after two to three days.
• If pain and soreness increases after lumpectomy surgery, call your surgeon to check for infections or other complications, which are not common following a lumpectomy.
• The doctor usually discourages the woman from attempting to lift anything over five pounds for the first several days following surgery. Other physical activities may also be discouraged.
• The doctor usually recommends that she continuously wear a bra that fits well for about a full week after surgery.
• Some women may have drainage tubes inserted into the armpit that collect blood and other fluid during the initial healing process. You may have to empty the drains and measure the fluid. She should report any problems to her doctor.
• Rarely, the cancerous cells are found during lumpectomy surgery are present at the edge of the removed breast lump (margin). This is referred to as a positive margin and may indicate that the tumor was not completely removed. In this case, re-excision of the breast to remove a wider rim of breast tissue around the cancer is typically performed.

If you notice any of these symptoms and signs after lumpectomy surgery, call your your doctor right away.

• Signs of infection-swelling, redness, tenderness
• Increasing pain
• Excessive bleeding or discharge of fluid
• Chest pain or shortness of breath
• Vomiting or nausea
• Signs of infection or fluid buildup in the underarm

The healing and recovery process after lumpectomy surgery is quicker when when you return to work and are back to your normal routine. Make sure that you are physically and emotionally read to go back to work. 

Ask yourself or your doctor these questions before you go back to work and other usual acivities.

• Am I emotionally ready to go back to work and get back to your normal schedule?
• Am I physically ready to go back to work and get back to your normal schedule?
• What are the risks or complications if you go back to work and your normal schedule too soon?
• How much is lumpectomy surgery?
• Does your medical insurance cover the procedure?
• How much will your medical insurance cover after you have paid the deductable? 

However, if you return to work and your normal routine too soon, it may add to more time to your healing and recovery time.

After a lumpectomy without a lymph node biopsy, you're likely to feel well enough to return to work after two or three days. You can usually resume normal physical activities, like going to the gym, after one week.

Follow-up visit: The woman and her doctor schedule a follow-up visit, which is usually 10-14 days following surgery. This is intended to check the progress of the healing process. In addition, the woman and her doctor usually discuss the results of the pathology report and any additional treatments or therapies that may be necessary.

Radiation therapy: This is used as an attempt to kill any cancer cells that may have been missed during the lumpectomy and has cancer. Radiation therapy is a standard follow-up treatment for any woman who has had a lumpectomy. The woman is typically scheduled to receive radiation therapy for about six weeks beginning as soon as possible after the lumpectomy, usually after the breast has been given some time to heal (about a month). Radiation therapy is given daily, with each session usually lasting a half hour or less, and does not cause any pain. Some women with small tumors may be candidates for local breast irradiation that is given twice a day for five days. The radiation therapy doctor can discuss the options with you.

Results of testing the tissue samples: After a lumpectomy, the woman and her doctor wait for test results involving the tissue samples taken during the surgery. Results of the test usually take a few days. If no cancer cells are found in the surrounding rim of tissue around the cancer, this means that the woman has clear margins around the tumor. If cancer cells are found in this tissue, this is called positive margins, and a follow-up surgery or other treatment must be performed to attempt further removal of the cancer.

Other therapies: Chemotherapy may be given to the woman, especially if tests reveal that the cancer has spread to her lymph nodes. The doctor may also prescribe tamoxifen (Nolvadex) or recommend other hormone therapy if the cancer cells express hormone receptors (estrogen or progesterone receptors). Anti-HER2 therapy is given if the cancer cells overexpress the HER-2 protein, a protein involved in cell growth. Endocrine therapy may be prescribed either after, or instead of chemotherapy, depending upon the characteristics of the breast cancer. Clinical trials may be an option for some women. Clinical trials are designed to test new drugs or new dosages or combinations of existing drugs as well as other aspects of cancer care.

The risks involved with lumpectomy are typical of any surgical procedure, which include

• Infection, bleeding, and damage to nearby tissues.
• General anesthesia is associated with some risks, however; they are rare.
• Rarely, a few women who are generally healthy experience serious complications from general anesthesia.
• Additional medical and cosmetic risks associated with lumpectomy.
• Depending on how much of the breast was removed during the lumpectomy, the appearance of the breast may change. The breast may have a visible scar or dimpling and may become asymmetrical in relation to the other breast.
• Some women may experience some nerve damage, which may cause a loss of sensation in the breast.
• Some women who receive a sentinel node biopsy or axillary lymph node dissection may lose some sensation in the underarm or range of motion in the shoulder. Other sensations may also be affected.
• Two to ten percent of women who undergo axillary lymph node dissection may develop lymphedema, which is the buildup of fluid in the area of the lymph nodes.
• Lymphadema can develop immediately or even years after the procedure.
• If women have had an axillary lymph node dissection, they should avoid anything tight around the arm (like a tourniquet used to draw blood, a blood pressure cuff, or a tight band on a sleeve) on that side for the rest of their life.
• Phlebitis may develop, which means the arm vein becomes inflamed.
• Cellulitis may occur. This is inflammation of the skin of the arm.

Risks associated with radiation therapy.

• Fatigue
• Nausea
• Hair loss of the treated area
• Loss of appetite
• Skin reactions of the treated area, including redness or rash

• The recurrence rate of breast cancer in women who receive a lumpectomy with radiation therapy is low.
• The results of a lumpectomy largely depend on the location, size, and type of lump found.
• Women with benign (noncancerous) lumps usually experience few complications.
• The outcome associated with a malignant (cancerous) lump may depend on if the cancer has spread, how quickly it is spreading, and what parts of the body are now affected.
• For cancer that is difficult to control and contain, the doctor may discuss complete mastectomy with breast reconstruction as a surgical option.