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.
Q. What’s the recovery period like? How long will I be out of work?
A. That varies a lot from woman to woman. Some women go back to work the next day. Some feel more comfortable waiting until the incision has healed more fully. If you have a job that’s physically taxing (e.g., child care, manufacturing), you’ll need to take enough time to heal the wound completely; your surgeon will advise you about that.
If you had a general anesthetic, you’ll probably feel a bit under the weather and woozy for a day or two. And you’ll almost certainly feel fatigued; this is a typical after-effect of surgery, any kind of surgery.
You may or may not need pain medications. You’ll probably feel a bit of discomfort and will want to sleep on your back, or the side not operated on. If you’re large-breasted, be sure to wear a bra with lots of support, to keep the incision as immobilized as possible until it heals. The nurses will give you complete instructions about bathing, and watching for signs of infection.
Finally, your surgeon may recommend arm exercises to prevent pain and encourage range of motion. (S)he will send you home with an illustrated set of instructions. If you’re advised to do arm exercises, do them; they’ll help prevent shoulder issues down the road.
Q. I’ve heard about women having 2 or 3 lumpectomies, one right after the other. What’s that about?
A. The goal of any lumpectomy is to remove all of the tumor, yet as little of your breast as possible. That’s why lumpectomy is often referred to as breast conservation surgery.
You’ll no doubt hear your surgeon talk about "margins" or "resection margins," which refer to the area of breast tissue directly surrounding the tumor. Your goal is to have "clear," "clean," or "negative" margins. That means the tissue surrounding the tumor shows no cancer cells.
After the surgeon has removes your tumor, it’s sent to pathology. The ensuing pathology report will note whether (and where) cancer cells are found, anywhere between the tumor and the far edges of the tissue surrounding it. If cancer cells are found at the edge of the sample, you have "positive" margins. This signals the need for further surgery.
You may have several surgeries in order to obtain clear margins. If you’ve had several surgeries, and the pathologist is still finding cancer cells in the tissue, your surgeon may suggest a mastectomy.
Q. Are there any long-lasting effects from a lumpectomy?
A. You may have some itching or feel some numbness around the incision and ensuing scar, as you would with any surgery. And you may have a "divot" in the contour of your breast, if the tumor was particularly large. Ask your surgeon, prior to surgery, if reconstruction would provide a better cosmetic outcome. A new type of surgery, called oncoplasty, combines lumpectomy and reconstruction in one operation.