Lumpectomy (also called breast conserving surgery or wide excision) is usually done under general anesthesia, which means that a woman is unconscious during the surgery. The surgeon makes an incision in the breast and removes the tumor, along with a small amount of normal tissue from around the tumor. The surgeon then closes the incision with stitches, trying to keep the breast looking as much like it did before surgery. The tissue that is removed will be sent to a pathologist for detailed testing, including assessment of margins.
Breast cancers found by mammograms or other X-rays are often hard to feel in the breast. If the tumor cannot be felt by the surgeon (called nonpalpable), a procedure called wire-localization or needle-localization will be done before surgery. A radiologist uses a mammogram or ultrasound as a guide to insert a very thin wire into the breast in the area of the tumor. The surgeon then uses this wire to find the tumor during surgery.
Assessing Lymph Nodes (Has cancer spread to the lymph nodes?)
During surgery for invasive cancer, some of the lymph nodes in the armpit (axillary nodes) are removed to learn if cancer has spread there. The presence or absence of cancer in these nodes is one of the most important factors affecting prognosis.
To see if cancer has spread to the axillary nodes, most people have a procedure called sentinel node biopsy. During this procedure, the surgeon injects a radioactive substance and/or blue dye into the breast near the tumor. Then, using the radioactivity and/or dye as a guide, he/she locates the first node(s) that filters lymph fluid from the tumor site (the sentinel node). Sometimes more than one node is labeled as a sentinel node. The node is removed and checked by the pathologist for cancer cells. If cancer is not found in the sentinel node (the sentinel node is “negative” for cancer), it is unlikely that other lymph nodes in the armpit have cancer and no further surgery is needed. If the sentinel node does contain cancer cells (the sentinel node is “positive”), then more nodes are taken out with a procedure called axillary dissection. This removes the cancer from this area. Axillary dissection is more invasive than a sentinel node biopsy. It disrupts more of the normal tissue in the armpit and is more likely to affect arm function and cause lymphedema . This has made sentinel node biopsy the preferred first step to assessing lymph nodes.
Not everyone is a candidate for sentinel node biopsy. Certain factors can lower the accuracy of the procedure. And, sometimes, the sentinel node cannot be found. Sentinel node biopsy is also not done if suspicious lymph nodes are found on a physical examination. In these cases, an axillary dissection is done.
For more on sentinel node biopsy and axillary dissection, see the Diagnosis section.
For more on lymphedema, see the After Treatment section.
Length of Hospital Stay
The length of the hospital stay after lumpectomy depends largely on whether axillary nodes were removed. People who have a sentinel node biopsy or who do not have lymph nodes removed often go home the day of their surgery. Those who have a standard axillary dissection may go home the same day, or they may stay in the hospital for a day or two. You should discuss the expected length of your stay with your surgeon and insurance provider.
Assessing Margins (Was the entire tumor removed during surgery?)
After surgery, a pathologist checks the tumor to determine its size and to make sure that it has been fully removed. The normal tissue around the tumor is called the margin. These margins of normal tissue help show whether or not the entire tumor was removed. Clean (also called uninvolved or negative) margins mean that there is only normal tissue (and no cancer cells) at the edges of the tissue removed. In these cases, no more surgery is needed. If normal tissue does not completely surround the tumor (called involved or positive margins), more surgery is usually done to get clean margins.
To further ensure complete removal of the tumor, the breast tissue that was removed is sometimes X-rayed. This is useful when microcalcifications were found on a mammogram. If the X-ray shows microcalcifications are still present, more breast tissue will be removed. For more on microcalcifications, see the Breast Facts section.
Updated 08/24/09
