Lumpectomy (also called breast conserving surgery or wide excision) is often done under general anesthesia, which means you are unconscious (asleep) during the surgery. In some cases, regional anesthesia may be used.
The surgeon makes an incision (cut) in the breast and removes the tumor, along with a small rim (area) of normal tissue surrounding the tumor. He/she then closes the incision with stitches, trying to keep the breast looking as much like it did before surgery. The surgeon may also make an incision in the underarm area and remove some lymph nodes.
In some cases, more than one surgery is needed to get clean margins. Clean (also called uninvolved or negative) margins mean there is only normal tissue (and no cancer cells) at the edges of the tissue removed from the breast. Learn more about assessing margins.
The tissue removed during surgery is sent to a pathologist for detailed testing. Learn about the results of the tests and other information found in your pathology report.
Finding the tumor in the breast
In some cases, the surgeon uses special methods to help find the exact part of the breast that contains the tumor.
Wire-localization (needle-localization) at the time of surgery
Sometimes breast cancers found by mammography (or other imaging) are nonpalpable (cannot be felt). If the tumor is nonpalpable, a procedure called wire-localization or needle-localization will be done just before surgery. A radiologist uses a mammogram, ultrasound or breast MRI as a guide and inserts a very thin wire into the breast in the area of the cancer. The surgeon then uses this wire as a guide to find and remove the tumor during surgery. The wire will also be removed during surgery.
Radio-opaque clip during a needle biopsy
If you can have neoadjuvant (before surgery) therapy, you will have a needle biopsy to remove a small amount of tumor tissue before treatment begins. A radio-opaque clip is often placed in the tumor bed during the biopsy. Later, when you have breast surgery, the surgeon uses the clip as guide to find and remove the remaining tumor during surgery. The clip will also be removed during surgery.
Learn more about neoadjuvant therapy.
Assessing lymph nodes (Has cancer spread to the lymph nodes?)
During surgery for invasive breast cancer, some of the lymph nodes in the underarm area (axillary nodes) are removed to check for cancer cells. The axillary nodes are often the first place breast cancer spreads. The presence or absence of cancer in these nodes is one of the most important factors affecting cancer stage and prognosis.
Sentinel node biopsy and axillary dissection
To see if cancer has spread to the lymph nodes in the underarm area (axillary nodes), most people have a procedure called sentinel node biopsy. During or before this procedure, a radioactive substance (called a tracer) and/or a blue dye is injected into the breast. The first axillary node(s) to absorb the tracer or dye is called the sentinel node(s). This is also the first axillary node(s) where breast cancer is likely to spread. The surgeon locates the sentinel node(s) by looking for the node that has absorbed the tracer (using a special device called a gamma probe) or the dye (which turns the lymph node(s) blue). The radioactive tracer or blue dye usually identifies one to five nodes as the sentinel nodes. The surgeon removes the sentinel node(s). A pathologist then checks the removed node(s) for cancer cells.
If cancer is not found in the sentinel node(s) (the sentinel node(s) is “negative”), it is unlikely that other axillary nodes have cancer. So, no further surgery will be needed.
If the sentinel node(s) does contain cancer cells (the sentinel node(s) is “positive”), more nodes may be removed with a procedure called axillary dissection (see more below). The goals of axillary dissection are to check how many axillary nodes have cancer and to reduce the chances of cancer returning in the axillary nodes. Some people with one or two positive sentinel nodes may not need axillary dissection.
Axillary dissection removes more tissue than a sentinel node biopsy. Because it disrupts more of the normal tissue in the underarm area, axillary dissection is more likely to affect arm function and cause lymphedema. For this reason, sentinel node biopsy is the preferred first step to check the axillary nodes.
Learn more about lymphedema.
Who cannot have a sentinel node biopsy?
In some cases, an axillary dissection instead of a sentinel node biopsy is advised. This usually occurs when:
- A person cannot have a sentinel node biopsy (for example, a person who has had a prior lymph node surgery)
- The sentinel node(s) cannot be found
- The physician feels suspicious lymph nodes in the underarm area (axillary nodes) and a needle biopsy prior to surgery shows the nodes contain cancer
Learn more about sentinel node biopsy and axillary dissection.
Positive sentinel lymph node and axillary dissection
In the past, almost everyone with a positive sentinel lymph node(s) was advised to have an axillary dissection to make sure all the cancer was removed from the underarm area. Studies now suggest that some women with one or two positive sentinel lymph nodes who have a lumpectomy, and who are going to get whole breast radiation therapy, may not need axillary dissection [6-8]. If you have a positive sentinel lymph node(s), talk to your health care team about whether you need to have axillary dissection.
Length of hospital stay
The length of the hospital stay after lumpectomy depends largely on whether lymph nodes in the underarm area (axillary nodes) are removed. If you have a sentinel node biopsy or you do not have axillary nodes removed, you will likely go home the day of your surgery.
If you have axillary dissection, you may go home the same day or you may stay overnight in the hospital. A tube (surgical drain) may be placed in the underarm area to collect fluid. This drain stays in for a week after surgery.
You should discuss the expected length of your stay with your surgeon and insurance provider.
What to expect after lumpectomy
After lumpectomy, you are likely to have temporary soreness in your chest, underarm and shoulder. You are also likely to have numbness along the surgical incision (scar).
If lymph nodes in the underarm area (axillary nodes) are removed during surgery, you may also have some numbness in your arm and there is some risk of lymphedema. Lymphedema is a condition where fluid collects in the arm (or other area such as the hand, fingers, chest or back), causing it to swell.
Learn more about the management of surgery-related pain.
Learn more about lymphedema.
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 that 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 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. These surgeries are complex. You may wish to meet with a plastic surgeon to discuss your options.
Learn more about breast reconstruction.
Assessing margins (Was the entire tumor removed during surgery?)
A pathologist checks the tissue removed during surgery. By looking at the tissue under the microscope, the pathologist determines whether the entire tumor was removed. The pathologist looks at the rim of tissue (called a margin) surrounding the tumor to check whether it contains cancer cells.
Negative (also called “clean,” “not involved” or “clear”) margins
- The margins do not contain cancer cells. (There is only normal tissue at the edges of the tissue removed from the breast.)
- No more surgery is needed.
Positive (also called "involved") margins
- The margins along the edge of the biopsy contain cancer cells.
- More surgery may be needed to get clear margins. (This should be discussed with your surgeon.)
- Sometimes it is not possible to get a clear margin due to its location (for example, if it is at the chest wall).
- The cancer cells approach, but do not touch the edge of the biopsy.
- More surgery may or may not be needed. (This should be discussed with your surgeon.)
- To further ensure the tumor has been fully removed, the removed breast tissue may be X-rayed. This is useful when microcalcifications were found on a mammogram and are related to the cancer. Depending on the results of the X-ray, more tissue may be removed at the time of the surgery.
Learn more about microcalcifications.
Transportation and lodging assistance
You may not live near the hospital where you will have your surgery. Sometimes, there are programs that offer help with local or long-distance transportation and lodging. Some also offer transportation and lodging for a friend or family member going with you. There are also financial assistance programs to help you with child care and elder care. Learn about transportation, lodging, child care and elder care assistance.
Susan G. Komen®’s Breast Care Helpline
To learn more about these programs and other helpful resources, call Komen’s breast care helpline at 1-877 GO KOMEN (1-877-465-6636). When you call, you will speak with a trained and caring staff member who can help you navigate your way through all of the complex breast cancer information as well as help you find resources.