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Breast lump removal

  • Definition
    • Breast lump removal is surgery to remove a lump that may be breast cancer. Tissue around the lump is also removed. This surgery is called a lumpectomy.

      When a noncancerous tumor such as a fibroadenoma of the breast is removed, it is often called an excisional breast biopsy, instead of a lumpectomy.

  • Alternative Names
    • Lumpectomy; Wide local excision; Breast conservation surgery; Breast-sparing surgery; Partial mastectomy

  • Description
    • If the breast cancer can be seen on imaging tests but the doctor cannot feel it when examining you, a wire localization will be done before the surgery.

      • A radiologist will use a mammogram or ultrasound to place a needlewire (or needlewires) in or near the abnormal breast area.
      • This will help the surgeon know where the cancer is so that it can be removed.

      Breast lump removal is done as an outpatient surgery most of the time. You will be given general anesthesia (you will be asleep, but pain-free) or local anesthesia (you are awake, but sedated and pain-free). The procedure takes about 1 hour.

      The surgeon makes a small cut on your breast and removes the cancer and some of the normal breast tissue around it. A pathologist examines a sample of the removed tissue to make sure all the cancer has been taken out.

      • When no cancer cells are found near the edges of the removed tissue, it is called a clear margin.
      • To see if cancer has spread to the lymph nodes, your surgeon may also remove lymph nodes in your armpit.

      Sometimes, small metal clips will be placed inside the breast to mark the area of tissue removal. This makes the area easy to see on future mammograms, and it helps guide radiation therapy, when needed.

      The surgeon will close your skin with stitches. These may dissolve or need to be removed later. Rarely, a drain tube may be placed to remove extra fluid. Your doctor will send the lump to a laboratory for more testing.

  • Why the Procedure Is Performed
    • Surgery to remove a breast cancer is most often the first step in treatment.

      The choice of which surgery is best for you can be difficult. It may be hard to know whether lumpectomy or mastectomy (removal of the entire breast) is best. You and the health care providers who are treating your breast cancer will decide together. In general:

      • Lumpectomy is often preferred for smaller breast lumps. This is because it is a smaller procedure and it has about the same chance of curing breast cancer as a mastectomy.
      • Mastectomy to remove all breast tissue may be done if the area of cancer is too large to remove without deforming the breast.

      You and your doctor should consider:

      • The size of your tumor
      • Where it is in your breast
      • If there is more than one tumor
      • How much of the breast is affected
      • The size of your breasts
      • Your age
      • Your family history
      • Your general health, including whether you have reached menopause
  • Risks
    • Risks for any surgery are:

      • Bleeding
      • Infection
      • Reactions to medicines

      The appearance of your breast may change after surgery. You may notice dimpling, a scar, or a difference in shape between your two breasts. Also, the area of the breast around the incision may be numb.

      You may need another procedure to remove more breast tissue if tests show the cancer is too close to the edge of the tissue already removed.

  • Before the Procedure
    • Always tell your doctor or nurse:

      • If you could be pregnant
      • What drugs you are taking, even drugs or herbs you bought without a prescription

      During the days before your surgery:

      • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot.
      • Ask your doctor which drugs you should still take on the day of your surgery.
      • If you smoke, try to stop. Your doctor or nurse can help.

      On the day of surgery:

      • Follow your doctor's instructions about eating or drinking before surgery.
      • Take the drugs your doctor told you to take with a small sip of water.
      • Your doctor or nurse will tell you when to arrive for the procedure.
  • After the Procedure
    • The recovery period is very short for a simple lumpectomy. Many women have little pain, but if you do feel pain, you can take pain medicine, such as acetaminophen.

      Your skin should heal in about a month. You will need to take care of the surgical cut area. Change dressings as your doctor or nurse tells you to. Watch for signs of infection when you get home (such as redness, swelling, or drainage from the incision).

      You may need to empty a fluid drain a few times a day for 1 to 2 weeks. Your doctor will remove the drain later.

      Most women can go back to their usual activities in a week or so. Avoid heavy lifting, jogging, or activities that cause pain in the surgical area for 1 to 2 weeks.

  • Outlook (Prognosis)
    • The outcome of a lumpectomy for breast cancer depends mostly on the size of the cancer and if it has spread to lymph nodes underneath your arm.

      A lumpectomy for breast cancer is usually followed by radiation therapy and treatment such as chemotherapy, hormone therapy, or both.

      Women usually do not need breast reconstruction after lumpectomy.

  • References
    • Cuzick J, DeCensi A, Arun B, Brown PH, Castiglione M, Dunn B, et al. Preventive therapy for breast cancer: a consensus statement. Lancet Oncol. 2011. 12:496-503. PMID: 21441069

      Heisey RE, McCready DR. Office management of a palpable breast lump with aspiration. CMAJ. 2010;182:693-6. PMID: 20194561

      Hunt KK, Green MC, Buchholz TA. Diseases of the breast. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL. Sabiston Textbook of Surgery. 19th ed. St. Louis, MO: Elsevier Saunders; 2012:chap 36.

      Wolff AC, Domchek S, Davidson NE, Sacchini V, McCormick B. Cancer of the breast. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Churchill Livingstone; 2013:chap 91.