Lumpectomy

A woman is a candidate for lumpectomy if the following conditions apply:

• A diagnosis of breast cancer is suspected.
• The size and location of the cancer are such that removal of the lump will still result in the remaining breast being acceptable to the woman.
• Cancer is only in a single site within the breast.
• The cancer to be removed is not a recurrence of cancer previously found in that breast.

The woman is put to sleep with conscious sedation or general anesthesia. The skin over the affected breast, chest, and upper arm is cleaned. An incision is made around the previous biopsy site and the surrounding skin is removed. The goal is to remove all of the cancerous breast tissue and leave the rest of the breast intact.

Bleeding is stopped and the wound is irrigated. A small drain may be placed in the wound. The incision is carefully closed to minimize scarring. Some lymph nodes under the arm may be removed to see if cancer has spread. This is called an axillary node dissection. It requires a separate incision in the underarm area. A small drain may be used here, too.

The incision is carefully closed to minimize scarring. The breast tissue and lymph nodes removed are sent to a lab for analysis. Bandages are applied and the woman is awakened.

The woman will be kept in the surgery recovery room for a short period of time. She will have an intravenous line (IV) and oxygen. The throat may be sore from the breathing tube used during the surgery. She will be asked to cough and breathe deeply to clean out the lungs and prevent pneumonia. Pain medication will be given as needed.

Back in the hospital room, the woman will usually need help getting up the first time. After that, she will be encouraged to get up and move about. She will be given something to eat and drink.

Most women can go home the next day. The bandages and drains remain in place until they are removed by the surgeon. Home care instructions are given.

The woman may need to periodically empty a reservoir attached to the drains. Care must be taken to keep all items clean to prevent infection. Proper hand-washing is very important before and after emptying the drains or changing dressings. A change in the color or increase in the amount of drainage should be noted and reported to the surgeon.

Pain medications are given, but the pain usually is not severe. The surgeon will let the woman know what activities are allowed in the first few days after surgery. After recovering from lumpectomy, most women undergo radiation therapy for the breast cancer. Women may have chemotherapy if the lab report shows that cancer has spread to the lymph nodes.

Many women feel sad or depressed after a lumpectomy. They may have concerns about body image and sexuality. Any diagnosis of cancer brings with it the fear of death. She should share her thoughts with the healthcare professional so that she can be given correct information. There are also support groups available with other women who have shared the same experience. It may be very helpful to talk with them.

Surgery can cause bleeding, infection, or a reaction to the anesthetic. Other complications of mastectomy include the following:

• Fluid can accumulate under the skin flaps
• Occasionally, if the skin flaps are very thin or if there is tension at the incision site, cell death of the skin edges of the incision may occur
• Numbness along the skin in the underarm area and upper arm is caused by damage to the nerves that travel through the area of the lymph nodes removed during surgery. Although it might take some time, this complication often will go away.
• Postmastectomy pain syndrome, or a severe, sharp, shooting, or burning pain along the chest wall. This is frequently caused by nerve damage.
• Swelling of the arm on the side of the surgery, which is called lymphedema, is often a late complication, which means that it can occur months or even years after surgery. This is from damage to the lymph vessels.

The following steps can help prevent lymphedema.

• Do not have blood drawn from the involved arm.
• Avoid having injections in the involved arm.
• Avoid having blood pressure taken in the involved arm.
• Avoid any injury to the involved arm, such as cuts, insect bites, or burns.
• Keep physically active, within the limits set by the healthcare professional.

Any new or worsening symptoms should be reported to the healthcare professional.