Lumpectomy

Lumpectomy is a surgical procedure done to remove cancer cells and other affected tissues from the breast. Lumpectomy is also known as breast-conserving surgery, wide local excision or partial mastectomy. In this surgery, only a small portion of the affected breast is removed. Sometimes, doctors may advise lumpectomy as an excisional biopsy procedure. In this surgery, while the doctors remove the affected lump, they also take some part of the surrounding normal or healthy tissue just to ensure that all the affected cells are removed. Lumpectomy is a very useful and effective surgical procedure as it assists in detecting cancer cells at an early stage. It is usually the first choice of treatment in many breast cancer cases. If the cancer cells are further detected after lumpectomy, the procedure of lumpectomy is followed by radiation therapy, in order to prevent the recurrence of the cancer cells. The lumpectomy is usually performed on a solid mass of breast, to detect its malignancy.


Why it’s done? What are the risks? How to prepare for the procedure? Expected results from the procedure

The main aim of the lumpectomy procedure is to remove the cancer-causing cells and the abnormal tissues, and also to maintain the normal appearance of the breast. This procedure is very useful as it helps in eliminating the risk of getting the cancer cells back again. The doctor advises going for a lumpectomy if the biopsy report detects cancer growth in a small area of the breast and also at an early stage. Lumpectomy is also helpful in eliminating other tissue abnormalities in the breast which are precancerous or non-cancerous in nature. There are some cases where the doctor does not advise going for lumpectomy and these cases are as mentioned below.

  • Previous radiation therapy on the breast might cause certain risks on further exposure to the radiations for the breast.
  • History of SLE or systemic lupus erythematosus or any chronic inflammatory disease. If radiation therapy is given in such cases, the condition of the patient may become worse.
  • If a patient has a history of scleroderma, then performing the surgical procedure of lumpectomy may create problems for the patient. In scleroderma, the skin of the patient becomes very hard and thick and hence, healing is very difficult after the lumpectomy procedure.
  • If the cancer cells have spread in the entire breast including the overlying skin, it is difficult to remove all the infected cells with the lumpectomy procedure. Lumpectomy is only helpful in removing some portion of the affected breast.
  • If the cancer growth is in different positions in the breast, undergoing lumpectomy procedure in such cases may result in distortion in appearance of the breast.
  • If the size of cancer or tumor is large and breast size is small, it may give poor aesthetic results.
  • In the pregnancy state, lumpectomy is not advised.

The cases in which the doctor advises the lumpectomy procedure are as mentioned:

  • A small tumor present in a single breast i.e. less than 5 cm in diameter.
  • In case there is a large amount of tissue mass present, the removal of the affected part through Lumpectomy would not change the aesthetics of the breast.
  • The patients who are medically fit for a surgical procedure and can take up the radiation therapy. 

There are some risks and complications associated with lumpectomy procedure, which are as mentioned:

  • Severe pain
  • Bleeding
  • Tenderness
  • Infections
  • Changes in the appearance and shape of the breast after the lumpectomy procedure.
  • Swelling, temporarily.
  • Formation of a hard scar or tissue at the site of lumpectomy.
  • Numbness in the breast after the lumpectomy due to nerve damage.
  • Exposure to radiation therapy, if the cancer cells are detected which may cause skin changes e.g. burning sensation at the biopsy site or redness, or fatigue.

If the lumpectomy procedure is under general anesthesia, then some patients may have some of the following complications:

  • Nausea
  • Vomiting
  • Uneasiness
  • Dizziness
  • A temporary state of confusion
  • A feeling of cold or shivering

The doctor discusses the details of the lumpectomy procedure, including the risks and the benefits of the surgery, with the patient. Some of the points to be considered before the surgery are as mentioned:

  • The doctor takes a complete medical history and physical examination test before performing the surgical procedure. The patient may be asked about the age and weight of the patient, any past surgeries, allergies to any medicines, previous personal history and family history of heart attacks. In the physical examination, the doctor examines the patient very carefully for any other concerning signs and symptoms.
  • The doctor also advises some tests such as some blood investigations, before the surgery
  • If a patient is diabetic, the patient is advised to ask the doctor if he/she should continue taking insulin before the procedure or not. The patient is also asked to inform the doctor about any past allergies or surgeries, if any.
  • The patient is advised to quit smoking and avoid alcohol, avoid drinking or eating anything after midnight or one night before the surgery.
  • The patient is advised to inform the doctor if he/she is taking any blood thinning medications or any supplements. Accordingly, the doctor would decide if the medication is to be stopped or can be continued.
  • The patient is advised to empty the urinary bladder and bowel, before the test.
  • The patient has to remove or avoid any jewelry, eyeglasses, hairpins, electronic gadgets or any metal objects and is asked to change into a hospital gown, during the procedure.
  • This surgical procedure does not need hospitalization after the procedure.
  • The patient is advised to bring a companion along to take care of the patient after the surgery and drive back home safely.

 

During the procedure:

The foremost step of the lumpectomy procedure is to identify the abnormal or affected area in the breast. If the report of the earlier conducted tests like mammography and biopsy is positive, then the radiologist usually places a clip or a marker in the affected part of the patient’s breast. Before the surgery, a radioactive marker or a fine wire is inserted in the breast. This wire or marker is then pushed down to the already placed clip or the marker. This is done to guide the surgeon to the exact affected area in the breast, which needs to be excised.

This wire insertion is done if the lump or the mass is not palpable or felt from above the breast. However in case, the mass is palpable, then it is easier for the surgeons to locate the abnormality.

Preparations for the removal of lymph nodes:

A small sample of the breast tissue is taken to identify if the cancer has spread or not. The sample can be taken by two methods, as mentioned below.

  • Axillary node dissection – This method is performed, if the doctor is sure that the cancer cells are present in the breast before the surgical procedure. In this procedure, the surgeon dissects a number of affected lymph nodes from the patient's armpit, besides the tumor site.
  • Sentinel node biopsy - Sentinel node biopsy is a procedure in which a small tissue sample is taken to test the presence of cancer and its spread into the lymphatic system. In this procedure, primary or first few lymph nodes are removed, wherein the drainage of the tumor is commonly observed.

There are two dyes/solutions used to locate the position of the sentinel lymph nodes, as mentioned below.

  • Radioactive solution - In this procedure, a weak radioactive solution is administered near the tumor cells. This radioactive solution travels through the lymphatic system, highlighting the sentinel lymph nodes. This solution is administered in the patient, a day or several hours before the removal of sentinel lymph nodes.
  • Blue dye - In this procedure, a blue colored harmless dye is administered near the tumor cells. This blue dye travels through the lymphatic system, highlighting the sentinel lymph nodes in a blue color. This dye is administered just before the surgical procedure of sentinel lymph nodes removal.

If the sentinel lymph nodes do not contain cancer cells, then cancer have not spread and the removal of additional lymph nodes is not required. However, if there is the presence of cancerous growth in the breast, then radiation therapy is used to eliminate the cancer cells and prevent them from recurring.

 

Lumpectomy procedure:

Before the lumpectomy procedure, the vital signs of the body such as pulse rate, body temperature, oxygen levels or breathing rate, and heart rate, are monitored continuously. General anesthesia is given to the patient to prevent from feeling any pain during the surgery.

When the patient is unconscious, a breathing tube may be inserted in the mouth and attached to the ventilator on the other end. This helps the patient to breathe normally during and even after the surgery (for some time). A small incision or cut is then made over the affected area. This incision depends upon the marked area, where the radioactive marker was placed if the lump is nonpalpable. Alternatively, the surgeon makes the incision over the palpable mass in the breast.

If the approach followed is axillary node dissection, the doctor removes only the sentinel lymph nodes, or a number of tissues. The sample is then sent to the lab for further detailed analysis. The affected cells are removed, the site is closed with either absorbable sutures or non -absorbable sutures, which will be removed by the doctor in a few days.

 

After the procedure:

The patient is shifted to the recovery room after the surgery wherein he/she is kept under continuous monitoring and observation. The vital signs of the body such as pulse rate, body temperature, oxygen levels or breathing rate, and heart rate, are monitored continuously.

The patient is allowed to go home the same day of the surgery and he/she can return back to normal routine activities, after consulting with the doctor. The speed of recovery depends on the medical condition of the patient. If any complications appear after the lumpectomy, then the physician can extend the stay in the hospital, until the condition of the patient is completely stable.

If the axillary node dissection technique is followed, then the hospitalization of the patient may be extended for a day or two. The hospitalization period would depend on the post-surgery pain or bleeding signs. The doctor applies a bandage or dressing over the surgery site. Pain killers may be advised by the doctor.

The patient is asked to avoid taking bath or showers for a few days after the procedure, however, sponging is allowed. The site of the biopsy should be kept clean, dry and moisture free. Some problems like tenderness and pain might exist for some days even after the procedure is done. Proper care should be taken of the biopsy site and of the medical condition of the patient.

The patient is asked to refrain from performing strenuous exercises for a few weeks until the wound heals properly. The results of the biopsy report would be made available soon to the patient and the doctor will discuss the report in detail with the patient. If the sample from the biopsy report confirms cancer or shows signs of cancer, then the doctor would discuss the treatment options with the patient.

After the procedure if the patient experiences any of the following signs, he/she should call the doctor immediately.

  • Chills
  • Severe or uncontrollable pain
  • Fever
  • Heavy bleeding from the biopsy site
  • Drainage or discharge from the biopsy site
  • Severe itching or any signs of infection
  • Swelling
  • Redness
  • Warm feeling

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