Breast-Conserving Surgery (Lumpectomy)

Breast-conserving surgery (BCS) may be used as part of a treatment plan for breast cancer. It is sometimes called a lumpectomy or a partial mastectomy depending on how much tissue is removed.

During BCS, only the part of the breast that has cancer is removed. The remainder of the breast is left intact. The cancer lump or abnormal tissue and some normal breast tissue around the lump (margin) are removed. How much of the breast is removed will depend on the lump’s size and its location.

The surgeon may also remove some of the lymph nodes under your arm to find out if the cancer has spread there. Breast cancer often spreads to these lymph nodes. It can then spread to other parts of the body (metastasize).

Radiation therapy is often given after BCS. This decreases the risk of the cancer returning. It destroys cancer cells that may not have been removed during surgery. In some cases, chemotherapy and radiation are both given after BCS.

Why might I need breast-conserving surgery?

BCS may be done as part of treatment for breast cancer. Deciding if you are a candidate for BCS depends on your type and stage of breast cancer and other factors. Your surgeon will discuss these with you during your consultation.

Studies show that women who have BCS for breast cancer followed by radiation therapy have similar long-term survival rates as women who have a mastectomy, which is when the entire breast is removed. There may be other reasons for your surgeon to advise BCS. But not all women can have BCS. Your surgeon will discuss these issues with you in detail, including all the choices for surgical treatment.

What are the risks of breast-conserving surgery?

All surgeries have some risk. Some possible complications of BCS include:

• Short-term (temporary) breast swelling
• A change in the size and shape of the breast
• Hardness due to scar tissue that can form at the incision site
• Wound infection or bleeding
• Swelling (lymphedema) of the arm, if lymph nodes were removed

A clear fluid (seroma) is often present in the wound after BCS. This can be drained in the surgeon’s office and treated with compression if needed.

There may be other risks depending on your specific health condition. Be sure to discuss any concerns with your healthcare team before the surgery.

Reconstructive surgery after breast-conserving surgery

Talk with your healthcare provider about how your breast may look after your surgery. Depending on how much of the breast is removed, it may look different afterward. Some type of reconstructive surgery may be a choice. Reconstruction can be done immediately after surgery or at a later time.

Talk with your healthcare team before surgery to know what to expect and what your choices are.

How do I get ready for breast-conserving surgery?

• Your healthcare provider will explain the procedure to you. Ask any questions that you might have.
• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
• Your healthcare provider will take your health history. They will also give you a physical exam. This is to be sure you are in good health before the surgery. You may also have blood tests or other tests.
• Follow any directions you are given for not eating or drinking before the surgery. Your surgeon will give you specific instructions.
• Tell your provider if you are pregnant or think you may be pregnant.
• Tell your provider if you are sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general).
• Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.
• Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.
• You may be given medicine to help you relax (a sedative) before the procedure.

Your healthcare provider may have other instructions for you based on your health condition.

What happens during breast-conserving surgery?

BCS may be done on an outpatient basis. This means you go home the same day. Or it may be done as part of a hospital stay. Procedures may vary depending on your condition and your healthcare provider's practices.

Generally, BCS follows this process:

1. You will be asked to remove clothing and given a gown to wear.
2. An IV (intravenous) line may be started in your arm or hand.
3. You will lie on your back on the operating table.
4. BCS may be done under local anesthesia with IV sedation. This means the area being operated on will be numbed. You will get medicine (sedative) in your IV before the procedure to help you relax. You will likely stay awake, but feel sleepy, during the surgery.
5. BCS may also be done under general anesthesia. You will be given medicine to put you into a deep sleep during surgery.
6. Your heart rate, blood pressure, breathing, and blood oxygen level will be checked during surgery.
7. The skin over the surgical site will be cleaned with a sterile solution.
8. A small cut (incision) will be made over or near the breast tumor. The healthcare provider will remove the lump or abnormality. They will also remove some of the normal breast tissue around it.
9. If the lymph nodes under your armpit are to be removed, a separate surgical cut may be made in or near the armpit.
10. Breast tissue and any other tissues that are removed will be sent to the lab for examination by a pathologist.
11. A drainage tube may be inserted into the affected area.
12. The skin will be closed with stitches or adhesive strips.
13. A sterile bandage or dressing will be placed over the site.

What happens after breast-conserving surgery?

In the hospital

After the procedure, you will be taken to the recovery room and watched closely. Your recovery process will vary depending on the type of procedure done and the anesthesia you are given. Once your blood pressure, pulse, and breathing are stable and you are alert, you may be taken to your hospital room.

In most cases, you will go home from the recovery room the same day as your surgery. You will receive instructions how to care for yourself at home and instructions when to call your healthcare provider.

At home

Once you are home, keep the surgical area clean and dry. Your healthcare team will give you specific bathing instructions. If adhesive strips were used, they should be kept dry. They often fall off in a few days.

The amount of pain you have will vary. It depends on the amount and location of tissue removed during surgery. Soreness should decrease over time. Take a pain reliever as advised by your healthcare team. Aspirin and some other pain medicines may increase your chance of bleeding. Be sure to take only medicines advised by your provider.

Your provider may instruct you to keep wearing a bra for support, for a period of time.

You will likely go back to your normal activities in 2 weeks. In the meantime, don't do anything strenuous. Follow any restrictions from your healthcare provider. Don’t do things that need using your arm too much. This includes lifting heavy objects, cleaning windows, or vacuuming for a long time. Your provider will tell you when you can start driving again and when you can go back to work.

BCS may be followed by radiation therapy. Your healthcare team will advise you about this, depending on your situation.

Know the number to call your healthcare provider, including after office hours, on weekend, and holidays. Tell your provider if you have any of the following:

• Fever or chills
• Redness, swelling, or bleeding or other drainage from the incision site
• More pain around the incision site
• Swelling or numbness or tingling of the affected arm, if lymph nodes were removed

Your healthcare provider may give you other instructions, depending on your situation.

Arm care after lymph node removal

Removing lymph nodes during BCS may affect how lymphatic fluid drains from your arm. Problems with lymphatic drainage can cause swelling in your arm. You may also be at greater risk for infection from injury to your arm. And there is a higher risk for blood clots in your armpit veins after surgery to the area.

You will have to follow certain safety steps for the rest of your life after lymph node removal. This will help prevent problems in the affected arm. These safety steps include:

• No needle sticks or IVs placed in the affected arm
• No blood pressure measurements in the affected arm
• Follow instructions about arm exercises carefully
• Avoid injuries, such as scratches or splinters, to the affected arm
• Raise (elevate) the arm, with your hand above your elbow, to help drain lymphatic fluid
• Wear gloves when gardening or doing any activity where there is a risk for getting a cut on your fingers or hands. Also wear gloves when using strong or harsh chemicals, such as detergents or household cleaners.
• Avoid sunburns
• Use a clean razor to shave under your arm
• Avoid wearing any tight items on the affected arm. This includes elastic cuffs, tight watches, or other jewelry.
• Use your good arm or both arms to carry heavy packages, bags, or purses
• Avoid insect bites or stings by using insect repellents or wearing long sleeves

Your doctor may give you other instructions, depending on your situation.