Written by : Dr.M.D.Mazumdar, MD
A lumpectomy is a conservative surgical procedure in which the breast cancer and a surrounding part of the normal tissue is removed. The entire breast or the drainng lymph nodes are not removed.
It is also known as partial mastectomy, quadrantectomy, or wedge resection. Technically, a lumpectomy is a partial mastectomy, because, not just the lump but also a part of the normal breast tissue is removed. Quadrantectomy means that a quarter of the breasts (roughly 1/4th ) will be removed.
Who is a fit candiate for a Lumpectomy?
- Women who have stage I breast cancer
- Women who are in stage II breast cancer.
- Women with DCIS (ductal carcinoma in situ)
- A small tumor in a large sized breast. A tumor less than 5 cm is ideal for a lumpectomy.
- If the tumor is in only one area of the breast.
- A woman with general good health who can receive radiation treatments after lumpectomy.
- Sometimes a large tumor can be shrunk by chemotherapy before surgery so that lumpectomy becomes possible. This is known as 'pre-operative' or 'neoadjuvant' chemotherapy.
- If the tumor is quite large and the breasts are small - this can cause the breasts to be very disfigured after a lumpectomy.
- If there are two or more areas with tumors or if the cancer is extensive.
- If there has been previous radiation to the chest for another cancer.
- If there is connective tissue disease, such as lupus or vasculitis - this increases the sensitivity to radiation.
- If a previous lumpectomy has failed to completely clear the tumor and the margins of the removed tissue contain cancerous cells even after a re-excision lumpectomy.
- If there is inflammatory breast cancer
- If the woman is pregnant.
- If it is not possible for the woman to come in for daily radiotherapy.
Advantages and Disadvantages of Lumpectomy
Lumpectomy has its own advantages and disadvantages.
Advantages of Lumpectomy
- The main advantage of a lumpectomy is that it can preserve much of the appearance and sensation of the breast especially if the tumor is small. Very often, a breast reconstruction surgery may not be needed at all.
- The recovery rate from lumpectomy is faster than with mastectomy. If lymph nodes are not removed during a lumpectomy, a patient may go back to work or go back to her active life within 2-3 days. If lymph nodes are removed, it may take up to 7 days for the scar to heal.
- The risks of cancer returning may be higher, especially if the tumor is larger and close to the skin.
- Lumpectomy needs to be followed by 4-6 weeks of radiotherapy.
- The time taken for radiation may delay breast reconstructive surgery.
- The size of the breast may become smaller than the other breast. Very often, the shape may also be altered - the breast may be mis-shapen or dimpled. However, breast reconstruction can restore the look of the breast to a great extent.
Re-excision Lumpectomy - During lumpectomy, a small area of normal tissue around the lump is also removed. This is then checked under the microscope for cancer cells. If no cancer cells are detected, this is noted as clear margins and radiotherapy can be started. Clear margins mean that the tissue farthest away from the breast tumor was free of any cancer cells.
But if cancer cells are detected in the normal tissue, a second lumpectomy , called 'Re-excision lumpectomy', may be performed to remove the tissue with cancer cells and a larger normal area around the operated area.
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