Lumpectomy/ Breast Conserving Surgery
Lumpectomy is known as breast-conserving surgery because it spares most of the breast tissue. Only the area containing the cancer surrounded by a margin of normal breast tissue is removed. If the cancer in your breast cannot be felt by touch you will have a procedure called needle localization immediately before your lumpectomy surgery. This procedure takes place in the breast imaging department. A mammogram or an ultrasound is done to pinpoint the location of the cancer in your breast. A thin wire is then inserted into this spot marking the area of breast tissue to be removed during surgery. After a lumpectomy, the entire breast is usually treated with Radiation Therapy to destroy any remaining cancer cells in the breast.
Recent studies involving thousands of women with 1- to 4-cm (about 2 inches) cancers have found that removal of the lump (lumpectomy) followed by radiation produces a cure rate equivalent to radical or modified radical mastectomy (removal of the breast and underlying tissue). For much larger tumors, mastectomy is usually recommended. Chemotherapy and radiation therapy can shrink breast cancers that are initially too large to be removed surgically.
During both lumpectomy and mastectomy, axillary (underarm) lymph nodes are generally removed and examined. Enlarged nodes under the arm may or may not contain cancer. Microscopic examination is required to document spread to lymph nodes. Involvement of lymph nodes in the armpit and under the sternum (breastbone) indicates a significantly aggressive and invasive tumor. An increased number of involved lymph nodes increases the probability of recurrence. Removal of lymph nodes can result in swelling of the arm on that side. Exercises can help minimize the problem. It is also helpful to avoid wearing a watch or bracelet, or carrying a handbag on that arm.
Learn more about lymph node removal below.
Breast cancer cells can travel in lymph fluid from the breast to lymph nodes in your underarm area, called the axilla. Your surgeon will remove some of the lyumph nodes in your axilla to send to a pathologist for examination. A pathologist is a doctor who uses a microscope and special tests to see if any cancer cells are present. The report from the pathologist gives your doctors important information that is used to decide if you need further treatment.
Your surgeon may recommend a sentinel lymph node biopsy. The 'sentinel' node is the first lymph node (or nodes) in your underarm that receives lymph fluid from the area in your breast where the cancer is located. These nodes are identified by injecting dye into the breast before surgery.
Lymph nodes from your axilla (underarm) may be removed for pathological examination. This may require a second incision in your armpit or through a lumpectomy incision. Currently, this procedure is limited to patients known to have lymph node involvement.
Special protocols are available to help prevent lymphedema after lymph node dissection.