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:
- Multiple cancers in separate locations of the same breast: This means that the potentially malignant tissue cannot all be removed from a single location, meaning that the breast may become drastically disfigured as a result of lumpectomy.
- Prior lumpectomy with radiation: Women who have had a lumpectomy with radiation therapy to remove cancer cannot have more radiation; therefore, they usually need a mastectomy if they experience cancer again in the same breast.
- Extensive cancer: Since a lumpectomy removes a specific area of malignancy, this surgery option would be inappropriate if the cancer has spread to other locations.
- Problematic tumors: A tumor that is rapidly growing or has attached itself to a nearby structure, such as the chest wall or skin, may require surgery that is more extensive to remove the tumor.
- Pregnancy: Radiation therapy, which usually follows the lumpectomy, can damage the woman's fetus.
- Large tumors: Lumpectomy to remove a tumor that is larger than 5cm in diameter may drastically disfigure the breast. However, in some cases, the size of the tumor may be able to be reduced with chemotherapy,
or endocrine therapy, to a size that is more manageable with lumpectomy. Small breasts, especially those that contain large lumps, may also be drastically disfigured after lumpectomy.
- Preexisting conditions that make radiation treatment more risky than usual: Radiation treatment may scar or damage connective tissue in women with collagen vascular diseases, such as scleroderma or lupus erythematosus.
- Prior radiation to the chest area, for instance, to treat Hodgkin's disease.
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.
Medically Reviewed by a Doctor on 6/24/2014
Leigh A Neumayer, MD, MS, FACS
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