In a lumpectomy, the surgeon removed just the breast lump or abnormal area and a margin of normal tissue around it. This is sometimes known as breast conserving surgery or partial mastectomy. Lumpectomy is the treatment of choice for early breast cancer where there is only one area of abnormal cells and the ability to obtain a rim of tissue around the cancer to decreases the risk of incomplete excision.
This procedure, which is performed as an outpatient surgical procedure under general anesthesia, removes the abnormal area and some lymph nodes, while leaving the breast. An area of normal tissue around the lump is also taken out to make sure that all cancerous cells have been removed. Your physician will discuss this with you.
Generally, patients may go home the same day if only a few nodes were removed and a drain was not inserted. If removal of multiple nodes is performed, called an axillary node dissection, then a drain is inserted and you may need to stay overnight in the hospital.
The lumpectomy will need eventual treatment with radiation treatment to nearly equal the local recurrence rate (cancer coming back in that area) of a masectomy.
About Lymph Nodes and Removal
The type and size of the breast cancer are important information in directing further treatment. Another important factor in staging and treatment decision making is if the cancer has spread to the lymph nodes. Lymph nodes are small, rounded glands that linked in chains and filter the lymph fluid of infection and cellular waste. Lymph nodes of the breast are found primarily in the armpit, or axilla. A few nodes are also located near the collarbone and breastbone. The first and most common area of lymph node spread for invasive breast cancer is the armpit.
The surgeon will need to know whether cancer has spread to the lymph nodes. In order to determine this, one or more of the axillary (underarm) lymph nodes are removed and examined under the microscope.
Doctors once believed that removing as many lymph nodes as possible was necessary and beneficial. However, removal of the normal lymph nodes does not actually benefit patients, and may be associated with complications. Now there are two ways to allow the doctor to determine whether breast cancer cells have spread to the lymph nodes: 1) axillary node dissection or sampling, and 2) sentinel node mapping or biopsy.
Removal of a sampling of lymph nodes, called an axillary node dissection or axillary sampling, is a standard procedure for determining if cancer has spread to the area or not. The number of nodes removed varies from person to person, but generally about 15 nodes are evaluated. This involves a second incision under the arm during the lumpectomy operation. Sometimes a small plastic tube, or drain is inserted to help the area heal.
Sentinel node mapping or biopsy is a fairly new procedure that identifies the first node or nodes into which a tumor drains, and the one cancer would most likely reach first. Most women have between one to four sentinel nodes. For sentinel node mapping, either the day before surgery of a few hours before surgery, a physician will inject a radioactive substance under the skin in an area around the nipple. To ease discomfort and stinging in the skin during injection, your physician may prescribe Emla cream to be applied on the designated area 2-3 hours before the injection.
In surgery, the surgeon may inject a blue dye into the area around the tumor or area of breast biopsy. Lymph vessels carry the radioactive substance and the blue dye into the sentinel node or nodes. The physician can see the dye or detect the radioactivity with a Geiger counter. He or she removes the sentinel node(s) by a small incision near the armpit and obtains a node or a few nodes for study under the microscope by a pathologist. If the sentinel node is cancer-free, usually it will not be necessary to remove many nodes, thereby reducing the chance a potential complication called lymphedema or accumulation of lymph fluid and swelling of the arm. If the immediate first look (or frozen section) of those sentinel nodes shows cancer metastasis to the lymph nodes, then the surgeon proceeds with axillary nodal dissection for accurate and complete staging. If because of previous surgery or biopsy, the dye or tracer does not go to the axilla, then the traditional axillary dissection will be done for complete staging.
The radioactive substance injected around your nipple will not pose any radiation danger to yourself or other persons around you. The blue dye sometimes causes harmless blue discoloration of your urine and skin tones which will resolve within a day or two. Although uncommon, there is a very small risk of an allergic reaction to the blue dye. Generally, the benefits of sentinel node mapping and biopsy offset any potential risks and temporary effects.
If on final path in 2-3 days, the sentinel nodes have now been shown to have cancer in them, your surgeon will discuss your case with oncology to decide if further lymph node removal is thought to change your treatment or outcome, and will be discussed with you for further decision making.
Whenever a patient has lymph node removal, she/he may experience temporary or permanent numbness or burning sensations on the inside of the upper arm. These sensations may lessen over several months after surgery. The procedure can also limit the arm and should movements. REFER TO INSTRUCTIONS FOR SHOULDER CARE AND RANGE OF MOTION EXERCISES included in this packet.
Without normal lymph drainage, fluids can accumulate and lead to arm and hand swelling, called lymphedema. No one can predict which patients will develop this condition or when. Lymphedema may arise immediately after surgery or even months or years later.
With care, patients can take precautions to avoid lymphedema.
Lumpectomy Discharge Instructions
As you prepare for discharge, you may have several questions and concerns. These instructions will hopefully help during the early days following discharge. If you have any questions, please contact your physician.
Moderate pain at the incision site(s) is expected. You may take Tylenol, Advil or Motrin. If a stronger pain medicine was prescribed, you should feel free to use it as directed, especially at first. Pain will decrease over time. Wearing a bra, perhaps even during sleep, may ease some discomfort.
Keep the dressing clean and dry. You may notice a small amount of drainage on the dressing. If you have a dressing, remove the dressing on day 2 after surgery, unless otherwise instructed by your doctor.
If you have staples or steristrips, leave them until your doctor removes them or they falloff. They will stay on about 2 weeks. If the edges of the steristrips curl up, you may trim them.
Ask your doctor when you may shower after surgery. Pat the area dry. Do not bathe until after your incision has healed. Avoid shaving under your arm until okayed by your physician. Do not use perfumes, deodorant, and powders around the incision.
It is recommended that you rest at home for 24 hours. Avoid vigorous physical activity such as repetitive motions such as sweeping, raking, or workouts of the arms and chest for 2 weeks or until your doctor advise. It is good to walk. You may run if you are wearing a very supportive bra.
If you have drains, empty the drains 2 to 3 times a day. Empty additional times if more than half full. Record drainage and bring it to your first doctors visit after surgery. Do not let drains dangle or pull. Refer to DRAIN CARE INSTRUCTIONS on the following page.
Notify your physician if you develop any of the following:
- Persistent temperature of 101 or greater
- Significant redness, swelling, or drainage from the incision or around drains (mild redness, swelling and drainage can be normal)
- Pain not relieved by pain medication