Lumpectomy (also called breast conserving surgery or wide excision) is often done under general anesthesia, which means you are unconscious (asleep) during the surgery. 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. The surgeon then closes the incision with stitches, trying to keep the breast looking as much like it did before surgery.
In some cases, more than one surgery is needed to get clean margins. This means the tissue around the tumor contains no cancer cells. Learn more about assessing margins.
The tissue removed during surgery is sent to a pathologist for detailed testing. Learn about your pathology report.
Breast cancers found by mammography (or other imaging may) be hard to feel in the breast. If the tumor is nonpalpable (cannot be felt), a procedure called wire-localization or needle-localization will be done before surgery. A radiologist uses a mammogram, ultrasound or 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.
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 axillary lymph 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 several (usually fewer than five) nodes as the sentinel nodes. The surgeon removes the sentinel node(s). A pathologist checks the removed node(s) for cancer cells.
If cancer is not found in the sentinel node (the sentinel node is “negative”), it is unlikely that other lymph nodes in the underarm area have cancer. So, no further surgery will be needed.
If the sentinel node does contain cancer cells (the sentinel node is “positive”), more nodes are sometimes removed with a procedure called axillary dissection (see more below). The goal of axillary dissection is to check how many lymph nodes have cancer, which may help determine if you will have chemotherapy after surgery. It also reduces the chances of cancer returning in the axillary lymph nodes. Some people with a positive sentinel node 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 lymph 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 cannot be found
- The physician feels suspicious lymph 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 was advised to have an axillary dissection to make sure all the cancer was removed from the underarm area. Recent studies suggest some women with one or two positive sentinel lymph nodes who have had lumpectomy, and who are going to get radiation therapy and adjuvant therapy, may not need axillary dissection [5-6]. If you have a positive sentinel lymph node, 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 axillary nodes are removed. If you have a sentinel node biopsy or you do not have lymph 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.
You should discuss the expected length of your stay with your surgeon and insurance provider.
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 and whether the margins (the edges of the tissue removed) are clean. 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. When the margins are clean, no more surgery is needed.
If normal tissue does not completely surround the tumor (called involved or positive margins), more surgery (called re-excision) may be done to get clean margins.
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. Learn more about these programs.