If you have found a lump in your breast, your physician might recommend an excisional surgical biopsy, also known as "lumpectomy". This does not mean that you have breast cancer: your lump (and some of the surrounding breast tissue) will be sent to a pathologist who'll determine whether it is malignant or benign.
Is Lumpectomy the Choice for Me?
Many women find themselves in the situation of being forced to choose to undergo a mastectomy or choose a breast conserving type of treatment (lumpectomy/radiation). Both of these procedures have equal survival rates, and this is a difficult decision for a woman to make.
At BreastHealthOnline we encourage you to educate yourself in all areas of treatment. If you choose a lumpectomy, it is important that you understand the radiation treatment that often follows the procedure. For those who choose a mastectomy, there are many decisions to be made regarding breast reconstruction. It is important to communicate your thoughts and wishes regarding your treatment to your physician and treatment team.
Lumpectomy -- Breast Conserving Surgery
In the early stages of breast cancer (stage 0) when there is only one tumor, some women may be candidates for lumpectomy with radiation, also known as breast conserving surgery. Other names that might be used for breast conserving surgery are biopsy, partial mastectomy, re-excision, quadrantectomy, and wedge resection.
Despite 25 years of use and research, there are many doctors today who don't recommend breast conserving surgery to their patients. While it is true that when you have breast cancer, the whole breast must be treated, this does not necessarily mean that you are in need of having your breast removed completely.
In essence, a lumpectomy is a "partial" mastectomy. It is performed in the hospital under general anesthesia and removes the tumor (lump) and some lymph nodes (or only the sentinel node) while leaving most of the breast intact. When the tumor is removed, an area of normal tissue around the tumor will be removed as well. This will be tested to be sure that there are no cancerous cells remaining. Surgery itself should take around 15-40 minutes. Talk to your surgeon about where the incision will be located and how it will be shaped. Many surgeons shape the scar in a crescent (smile or frown) to follow the natural curve of the breast and allow for better healing.
Most likely your surgeon will use a kind of electric scalpel that uses heat to minimize bleeding, called an electrocautery knife. If your lump is easily seen or felt it will be removed along with an area of normal tissue surrounding it. If your lump cannot be easily detected the surgeon will have used a mammogram or ultrasound procedure prior to surgery to locate and mark the tumor.
Sometimes a drain is inserted before the incision is stitched closed. The drain is used to collect excess fluid and blood that may accumulate in the area where the tumor was located. This drain, if used, will be removed at some point after surgery. Question your surgeon about whether drains will be used, proper care of them, and when they would be removed.
A lumpectomy is generally an outpatient procedure, meaning you will return home the day of the surgery. If you are having lymph nodes removed as well, an overnight stay would be required. Make sure to discuss this with your surgeon.
This surgery is generally followed by radiation treatments.
Questions about Lumpectomies
How can I be sure that a lumpectomy will "get it all"?
With breast cancer, no matter the course of treatment, generally we are never sure if it's all gone. Since lumpectomy is used only in early stage breast cancer, the chances of getting it all are very good. The area of normal tissue surrounding the tumor is removed in order to ensure that all the cancerous cells have also been removed. After the surgical area heals, it is also radiated to "burn out" any remaining cancer cells.
There is a chance of recurrence after any breast surgery. That's why it's so important that you be followed closely by your doctors so that if there is a recurrence, it is caught at a very early stage. Should a recurrence happen after lumpectomy you would have the same overall outlook as those women who had a mastectomy.
Will I need chemotherapy or hormonal therapy after a lumpectomy?
This will be determined by the results of the pathology tests performed on the lump, lymph nodes, and surrounding tissue removed during surgery. If there is reason to believe that the tumor has spread microscopically, chemotherapy and/or hormonal therapy would most likely be suggested in addition to radiation.
Which is better? Lumpectomy or mastectomy?
If you are in the early stages of breast cancer, it depends on your body and your wishes. Make sure you discuss what your doctor recommends and why he/she recommends it. Think about what decision you will be comfortable with several years down the road. What decision will allow you to sleep better at night? This is your lump, and these are your breasts.
* Make sure to get more then one opinion. In fact, get as many opinions as it takes to be comfortable with your doctor and your choice of surgery.
* When you discuss lumpectomy with a surgeon, make sure you find out how many he has performed and for what kind of cancer. You want a surgeon with lots of experience with lumpectomies and with your type of cancer.
* Connect with women who have had lumpectomies and mastectomies, and find out the pros and cons from their point of view.
* Think about how important it is for you to retain your breast. For some women, it's not an issue; for others, it's very important to retain as much of their natural breast as possible.
* Remember, no matter what anyone says, this is your body and your choice. You are not powerless.