Lumpectomy is a surgical procedure that involves removing a suspected malignant (cancerous) tumor, or lump, and a small portion of the surrounding tissue from a woman's breast. This tissue is then tested to determine if it contains cancerous cells. A number of lymph nodes may also be removed to test them for cancerous cells (sentinel lymph node biopsy or axillary dissection). If cancerous cells are discovered in the tissue sample or nodes, additional surgery or treatment may be necessary. Women who undergo a lumpectomy normally receive radiation therapy (RT) for about six weeks following the procedure to kill any cancer cells that may have been missed with the removal of the tumor. Lumpectomy is also referred to as partial mastectomy, wedge resection, breast conserving therapy, wide excision biopsy, tylectomy, segmental excision, and quadrantectomy.
A few decades ago, the standard surgical procedure to treat breast cancer was radical mastectomy, which involves the complete removal of the breast. Lumpectomy replaced radical mastectomy as the preferred surgical treatment because lumpectomy is designed to leave the natural appearance and cosmetic quality of the breast mostly intact while removing the malignancy. In addition, studies have shown that lumpectomy with radiation treatment is as effective as mastectomy in treating breast cancer.
The size and location of the lump determine how much of the breast is removed during a lumpectomy. A quadrantectomy, for example, involves removing a quarter of the breast. Before surgery, a woman should discuss with her doctor how much of the breast will be involved so that she can know what to expect.
The size of the cancer in relation to the size of the breast is the main factor that a woman's doctor considers to determine if a lumpectomy is an appropriate treatment. Additionally, some of the features of the cancer (if it is confined to one area of the breast and does not involve the skin or chest wall) help the doctor determine if lumpectomy is appropriate. Most women who are diagnosed with breast cancer, especially those who are diagnosed early, are considered good candidates for lumpectomy. However, under some circumstances, lumpectomy is not a recommended surgery for some women. These factors include the following:
Some women may prefer the idea of a mastectomy to lumpectomy in order to feel more confident that they will not develop breast cancer again. Other women may not feel comfortable with radiation therapy or be able to commit to a series of radiation treatments, which may involve an unacceptable time commitment or extensive travel. In most situations, though, women can safely choose between lumpectomy and mastectomy.
Leigh A Neumayer, MD, MS, FACS
Marga Massey, MD
Galen Poole, MD, FACS
Mary L Windle, PharmD
Lee P Shulman, MD
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