Lumpectomy (also known as breast conserving surgery or wide excision) is a surgery to remove cancer from the breast. Unlike a mastectomy, a lumpectomy removes only the tumor and a small rim (area) of the normal tissue around it. So, the breast looks as close as possible to how it did before surgery. Most often, the general shape of the breast and the nipple area are kept.
Radiation therapy is given after lumpectomy to get rid of any cancer cells that may remain. This lowers the chances of the cancer returning to the breast to about five to 10 percent .
When is lumpectomy plus radiation therapy an option?
Lumpectomy plus radiation therapy is the preferred option for most women who have early breast cancer or ductal carcinoma in situ (non-invasive breast cancer). In some cases, it is also an option for women with locally advanced breast cancer.
Women who are pregnant or who have certain health conditions cannot have radiation therapy and may need to have a mastectomy instead of a lumpectomy.
- Pregnancy. Radiation can harm a fetus, so it is not given during pregnancy. However, depending on the timing of the pregnancy and breast cancer diagnosis, a woman may be able to have a lumpectomy and put off radiation therapy until after delivery.
- Active scleroderma or systemic lupus. These disorders can keep tissue from healing correctly after radiation therapy.
- Past radiation therapy to the same breast or to the same side chest. In general, radiation therapy to the breast can only be given once. (In rare cases, radiation to the same breast may be repeated.)
When a lot of breast tissue must be removed to get rid of the tumor(s), a mastectomy may be a better option. This may be the case when:
- There are two or more tumors in different areas of the breast (multi-centric tumors).
- The tumor is large (relative to breast size).
- The tumor has spread throughout the breast (diffuse tumor).
- The mammogram showed large areas of calcifications in the breast.
- The tumor is located just beneath the nipple (such that the cosmetic look after lumpectomy will not be good).
- The surgical team cannot get negative margins (remove all the tumor) with multiple attempts by lumpectomy.
Although the exact treatment for breast cancer varies from person to person, treatment guidelines help ensure quality care. These guidelines are based on the latest research and the consensus of experts. The American Society of Clinical Oncology (ASCO) and National Comprehensive Care Network (NCCN) are two respected organizations that regularly update and post their guidelines online. The National Cancer Institute (NCI) also has overviews of treatment options.
Women may choose lumpectomy over mastectomy to keep their breast and have it look (as much as possible) like it did before surgery. Lumpectomy does change the look of the breast though. Because some tissue is removed, the breast may be smaller and firmer. There will be a scar (and some numbness). Radiation therapy (usually given after lumpectomy) can also affect the look of the breast. It can further shrink the breast and change its texture or feel.
Sometimes, factors like the location and size of the tumor can make it unlikely a woman will be happy with the look of her breast after lumpectomy. In these cases, mastectomy may be the better option.
In rare cases, a woman may also consider having reconstructive surgery (either at the time of their lumpectomy or later) to maintain a more natural appearance of the breast, or to match the size and shape of the opposite breast. You may wish to meet with a plastic surgeon to discuss this option.
Learn more about breast reconstruction.