Breast Cancer Surgery FAQS: Lumpectomy

Q. I’ve been diagnosed with breast cancer, and my doctor recommends a lumpectomy. I know that’s surgery, but what kind of surgery? Is it different than a mastectomy?

A. A lumpectomy, often referred to as breast conserving or breast conservation surgery, is the least invasive way to remove the tumor in your breast. Unlike a mastectomy (which removes your entire breast), a lumpectomy removes only the tumor, plus some tissue around it—a “safety cushion” to help ensure ALL of the cancerous tissue is gone.

You may have two or three lymph nodes removed from your armpit at the same time. When cancer spreads outside the breast, the first place it travels is to the lymph nodes under your arm. So the surgeon will “harvest” some lymph nodes to send to the pathologist along with the tumor. Both will be carefully examined: the tumor to assess the exact type and aggressiveness of the cancer you have, and the lymph nodes to see whether it’s spread.

Q. So, how big of a deal is it? Will I be in the hospital overnight?

A. Lumpectomy is usually considered same-day surgery. You’ll go into the hospital, change into a gown, and go through the usual prep: paperwork, waiting, etc. You’ll probably be asked to make an “X” or sign the breast on which you’re having surgery. You’ll also be given a light sedative, which will help you relax during surgery if you’re not having a general anesthetic.

Oftentimes, to mark the exact location of the tumor, you’ll go to radiology and the radiologist will use ultrasound or a mammogram to insert a small metal barb directly into the tumor. If the tumor is large enough to be felt easily, you probably won’t undergo this procedure.

If you’re having a sentinel node biopsy—a relatively new procedure that identifies the first lymph node to which cancer might spread—you’ll also have an injection of dye. During surgery, the dye will clearly identify which underarm lymph node(s) should be removed.

Surgery will be performed under local or general anesthetic, depending on the projected complexity of the surgery (is the tumor large and accessible? Small and hidden?), and/or you and your surgeon’s preference. The operation itself should take under an hour.

You’ll be sent back to the surgery waiting area to recover, probably for a couple of hours. If the tumor was particularly large, you may have a drain inserted into the cavity to collect and siphon off excess fluid. The drain might be removed before you leave the hospital; or it’ll be removed at your first follow-up visit, usually within a week after surgery.

You’ll probably be given pain medication, and a prescription for painkillers to use at home, if you need them. And that’s it; once the nurses deem you’re stable, and steady enough on your feet to travel, you’ll be sent home. You’ll be back to have the incision checked in a week or so, but essentially this part of your treatment is done.