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Breast lump removal

Lumpectomy; Wide local excision; Breast conservation surgery; Breast-sparing surgery; Partial mastectomy; Segmental resection; Tylectomy

Breast lump removal is surgery to remove a lump that may be breast cancer. Tissue around the lump is also removed. This surgery is called an excisional breast biopsy, or lumpectomy.

When a noncancerous tumor such as a fibroadenoma of the breast is removed, this is also called an excisional breast biopsy, or a lumpectomy.

Description

Sometimes, the health care provider cannot feel the lump when examining you. However, it can be seen on imaging results. In this case, a wire localization will be done before the surgery.

  • A radiologist will use a mammogram or ultrasound to place a needlewire (or needlewires) in or near the abnormal breast area.
  • This will help the surgeon know where the cancer is so that it can be removed.

Breast lump removal is done as an outpatient surgery most of the time. You will be given general anesthesia (you will be asleep, but pain free) or local anesthesia (you are awake, but sedated and pain free). The procedure takes about 1 hour.

The surgeon makes a small cut on your breast. The cancer and some of the normal breast tissue around it is removed. A pathologist examines a sample of the removed tissue to make sure all the cancer has been taken out.

  • When no cancer cells are found near the edges of the removed tissue, it is called a clear margin.
  • Your surgeon may also remove some or all of the lymph nodes in your armpit to see if the cancer has spread to them. 

Sometimes, small metal clips will be placed inside the breast to mark the area of tissue removal. This makes the area easy to see on future mammograms. It also helps guide radiation therapy, when needed.

The surgeon will close your skin with stitches or staples. These may dissolve or need to be removed later. Rarely, a drain tube may be placed to remove extra fluid. Your doctor will send the lump to the pathologist for more testing.

Why the Procedure Is Performed

Surgery to remove a breast cancer is most often the first step in treatment.

The choice of which surgery is best for you can be difficult. It may be hard to know whether lumpectomy or mastectomy (removal of the entire breast) is best. You and the providers who are treating your breast cancer will decide together. In general:

  • Lumpectomy is often preferred for smaller breast lumps. This is because it is a smaller procedure and it has about the same chance of curing breast cancer as a mastectomy. It is a good option as you get to keep most of your breast tissue that has not been affected by cancer.
  • Mastectomy to remove all breast tissue may be done if the area of cancer is too large or there are multiple tumors which cannot be removed without deforming the breast.

You and your provider should consider:

  • The size of your tumor
  • Where it is in your breast
  • If there is more than one tumor
  • How much of the breast is affected
  • The size of your breasts in relation to the tumor
  • Your age
  • Your family history
  • Your general health, including whether you have reached menopause
  • If you are pregnant

Risks

Risks for surgery are:

  • Bleeding
  • Infection
  • Poor wound healing
  • Heart attack, stroke, death
  • Reactions to medicines
  • Risks associated with general anesthesia

The appearance of your breast may change after surgery. You may notice dimpling, a scar, or a difference in shape between your breasts. Also, the area of the breast around the incision may be numb.

You may need another procedure to remove more breast tissue if tests show the cancer is too close to the edge of the tissue already removed.

Before the Procedure

Always tell your provider:

  • If you could be pregnant
  • What drugs you are taking, even drugs or herbs you bought without a prescription
  • Allergies you may have including medications and latex
  • Reactions to anesthesia in the past

During the days before your surgery:

  • You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), naproxen (Aleve, Naprosyn), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs that make it hard for your blood to clot. Be sure to ask your provider which medicines medications should be stopped, and for how long before your procedure.
  • Ask your provider which drugs you should still take on the day of your surgery.
  • If you smoke, try to stop for at least 2 weeks prior to the surgery. Your provider can help.

On the day of surgery:

  • Follow your provider's instructions about eating or drinking before surgery.
  • Take the drugs your provider told you to take with a small sip of water.
  • Your provider will tell you when to arrive for the procedure.

After the Procedure

The recovery period is very short for a simple lumpectomy. Many women have little pain, but if you do feel pain, you can take pain medicine, such as acetaminophen.

Your skin should heal in about a month. You will need to take care of the surgical cut area. Change dressings as your provider tells you to. Watch for signs of infection when you get home (such as redness, swelling, or drainage from the incision). Wear a comfortable bra that provides good support, such as a sports bra.

You may need to empty a fluid drain a few times a day for 1 to 2 weeks. You may be asked to measure and record the amount of fluid drained. Your provider will remove the drain later.

Most women can go back to their usual activities in a week or so. Avoid heavy lifting, jogging, or activities that cause pain in the surgical area for 1 to 2 weeks.

Outlook (Prognosis)

The outcome of a lumpectomy for breast cancer depends mostly on the size of the cancer, as well as the make up of the tumor. It also depends on its spread to lymph nodes underneath your arm.

A lumpectomy for breast cancer is most often followed by radiation therapy and other treatments such as chemotherapy, hormonal therapy, or both.

In most cases, you do not need a breast reconstruction after lumpectomy.

References

American Cancer Society. Breast-conserving surgery (lumpectomy). www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer/breast-conserving-surgery-lumpectomy. Updated September 13, 2017. Accessed November 5, 2018.

Bevers TB, Brown PH, Maresso KC, Hawk ET. Cancer prevention, screening, and early detection. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 23.

Hunt KK, Mittendorf EA. Diseases of the breast. In: Townsend CM Jr, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 20th ed. Philadelphia, PA: Elsevier; 2017:chap 34.

The American Society of Breast Surgeons. Performance and practice guidelines for breast-conserving surgery/partial mastectomy. www.breastsurgeons.org/docs/statements/Performance-and-Practice-Guidelines-for-Breast-Conserving-Surgery-Partial-Mastectomy.pdf. Updated February 22, 2015. Accessed November 5, 2018.

Wolff AC, Domchek SM, Davidson NE, Sacchini V, McCormick B. Cancer of the breast. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff's Clinical Oncology. 5th ed. Philadelphia, PA: Elsevier Saunders; 2014:chap 91.

    • Female Breast

      Female Breast - illustration

      The female breast is either of two mammary glands (organs of milk secretion) on the chest.

      Female Breast

      illustration

    • Needle biopsy of the breast

      Needle biopsy of the breast - illustration

      A needle biopsy is performed under local anesthesia. Simple aspirations are performed with a small gauge needle to attempt to draw fluid from lumps that are thought to be cysts. Fine needle biopsy uses a larger needle to make multiple passes through a lump, drawing out tissue and fluid. Withdrawn fluid and tissue is further evaluated to determine if there are cancerous cells present.

      Needle biopsy of the breast

      illustration

    • Open biopsy of the breast

      Open biopsy of the breast - illustration

      An open biopsy can be performed under local or general anesthesia and will leave a small scar. Prior to surgery, a radiologist often first marks the lump with a wire, making it easier for the surgeon to find.

      Open biopsy of the breast

      illustration

    • Breast self-exam

      Breast self-exam - illustration

      Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

      Breast self-exam

      illustration

    • Breast self-exam

      Breast self-exam - illustration

      Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

      Breast self-exam

      illustration

    • Breast self-exam

      Breast self-exam - illustration

      Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

      Breast self-exam

      illustration

    • Breast lumps

      Breast lumps - illustration

      Less than one-fourth of all breast lumps are found to be cancerous, but benign breast disease can be difficult to distinguish from cancer. Consequently, all breast lumps should be checked by a health care professional.

      Breast lumps

      illustration

    • Lumpectomy

      Lumpectomy - illustration

      Lumpectomy is a surgical procedure performed on a solid breast mass to determine if it is malignant. The suspicious lump and some surrounding tissue is excised and analyzed.

      Lumpectomy

      illustration

    • Causes of breast lumps

      Causes of breast lumps - illustration

      Most breast lumps are benign (non-cancerous), as in fibroadenoma, a condition that mostly affects women under age 30. Fibrocystic breast changes occur in more than 60% of all women. Fibrocystic breast cysts change in size with the menstrual cycle, whereas a lump from fibroadenoma does not. While most breast lumps are benign, it is important to identify those that are not. See your health care provider if a lump is new, persistent, growing, hard, immobile, or causing skin deformities.

      Causes of breast lumps

      illustration

    • Breast lump removal - series - Normal anatomy

      Breast lump removal - series - Normal anatomy

      Presentation

      • Female Breast

        Female Breast - illustration

        The female breast is either of two mammary glands (organs of milk secretion) on the chest.

        Female Breast

        illustration

      • Needle biopsy of the breast

        Needle biopsy of the breast - illustration

        A needle biopsy is performed under local anesthesia. Simple aspirations are performed with a small gauge needle to attempt to draw fluid from lumps that are thought to be cysts. Fine needle biopsy uses a larger needle to make multiple passes through a lump, drawing out tissue and fluid. Withdrawn fluid and tissue is further evaluated to determine if there are cancerous cells present.

        Needle biopsy of the breast

        illustration

      • Open biopsy of the breast

        Open biopsy of the breast - illustration

        An open biopsy can be performed under local or general anesthesia and will leave a small scar. Prior to surgery, a radiologist often first marks the lump with a wire, making it easier for the surgeon to find.

        Open biopsy of the breast

        illustration

      • Breast self-exam

        Breast self-exam - illustration

        Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

        Breast self-exam

        illustration

      • Breast self-exam

        Breast self-exam - illustration

        Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

        Breast self-exam

        illustration

      • Breast self-exam

        Breast self-exam - illustration

        Monthly breast self-exams should always include a visual inspection, with and without a mirror, to note any changes in contour or texture, and manual inspection in standing and reclining positions to note any unusual lumps or thicknesses.

        Breast self-exam

        illustration

      • Breast lumps

        Breast lumps - illustration

        Less than one-fourth of all breast lumps are found to be cancerous, but benign breast disease can be difficult to distinguish from cancer. Consequently, all breast lumps should be checked by a health care professional.

        Breast lumps

        illustration

      • Lumpectomy

        Lumpectomy - illustration

        Lumpectomy is a surgical procedure performed on a solid breast mass to determine if it is malignant. The suspicious lump and some surrounding tissue is excised and analyzed.

        Lumpectomy

        illustration

      • Causes of breast lumps

        Causes of breast lumps - illustration

        Most breast lumps are benign (non-cancerous), as in fibroadenoma, a condition that mostly affects women under age 30. Fibrocystic breast changes occur in more than 60% of all women. Fibrocystic breast cysts change in size with the menstrual cycle, whereas a lump from fibroadenoma does not. While most breast lumps are benign, it is important to identify those that are not. See your health care provider if a lump is new, persistent, growing, hard, immobile, or causing skin deformities.

        Causes of breast lumps

        illustration

      • Breast lump removal - series - Normal anatomy

        Presentation

      A Closer Look

       

      Tests for Breast lump removal

       

      Review Date: 10/30/2018

      Reviewed By: Jonas DeMuro, MD, Assistant Professor of Surgery, Stony Brook School of Medicine, Stony Brook, NY. Review provided by VeriMed Healthcare Network. Also reviewed by David Zieve, MD, MHA, Medical Director, Brenda Conaway, Editorial Director, and the A.D.A.M. Editorial team.

      The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition. A licensed medical professional should be consulted for diagnosis and treatment of any and all medical conditions. Links to other sites are provided for information only -- they do not constitute endorsements of those other sites. © 1997- A.D.A.M., a business unit of Ebix, Inc. Any duplication or distribution of the information contained herein is strictly prohibited.
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