Lumpectomy

What is a lumpectomy?

Lumpectomy (also called partial mastectomy) is the surgical procedure in which only a part of the breast is removed to eliminate a breast cancer.  This is in contrast with mastectomy, which involves removal of the entire breast.  Lumpectomy also requires removal of a narrow rim of healthy tissue surrounding the cancer to ensure that the entire cancer has been completely removed. We call this extra rim of normal tissue a “clear” margin. Lumpectomy usually requires radiation of the breast to reduce the risk of cancer recurrence in the remaining treatment.

Whenever possible, Dr. Holmes makes lumpectomy incisions in discrete areas of the breast so that the incisions are not obvious.  This includes incisions at the edge of the areola, in the armpit or the natural skin crease under the breasts.

View Lumpectomy of Right Breast

What are the advantages of a lumpectomy compared to mastectomy?

The combination of lumpectomy and radiation achieves the same long term cancer survival as mastectomy, but with fewer side effects and faster recovery.  Statistically, there is little difference between the recurrence rate between mastectomy vs. lumpectomy and radiation.  Therefore, lumpectomy and radiotherapy are preferred if the cancer is small enough to be removed completely with acceptable breast appearance.

Why is radiation recommended after lumpectomy?  

Radiation is usually recommended after lumpectomy to reduce the risk of cancer recurrence in the parts of the breast that remains after lumpectomy.  A 3-week or 6-week course of daily whole breast radiation is the most widely available form of radiation for women treated with lumpectomy.  Dr. Holmes is an expert in targeted intraoperative radiotherapy (TARGIT), a type of radiation that is targeted to the tumor site that is administered as a single treatment entirely during surgery at the time of lumpectomy.  Long-term studies of women with early-stage breast cancer show that TARGIT is safer but equally effective as daily whole breast radiation for preventing recurrences in the breast.  However, TARGIT is not the right treatment option for all lumpectomy patients.  Women with larger tumors or positive lymph nodes still require daily whole breast radiation to reduce the risk of recurrence in the breast and lymph node region.ancer (DCIS) that has been widely removed and for elderly women with stage I breast cancer whose cancers have been widely removed.

Am I a good candidate for a lumpectomy?

Most women diagnosed with early-stage breast cancer are candidates for lumpectomy.  The ability to perform a successful lumpectomy depends on the size of the cancer compared to the size of the breast,  the location of the cancer within the breast, and the skill of the surgeon.  We may sometimes recommend chemotherapy or anti-estrogen medications prior to surgery to shrink a cancer and make it more amenable to lumpectomy.

How is complete removal of the cancer ensured?

The goal of breast cancer surgery is to remove the cancer surrounded by a rim of normal tissue.  The main challenge of breast cancer surgery is that some parts of the cancer might not be detectable during surgery using standard procedures.  About 15-30% of women in the U.S. require multiple surgeries to completely remove breast cancer.  Dr. Holmes uses multiple strategies to improve the odds of a successful lumpectomy, resulting in an exceptionally low (5-10%) rate of repeat surgery. These strategies include:

• Preoperative MRI
• Intraoperative Ultrasound
• Bracketed Wire-Localization
• Intraoperative Pathology Consultation
• Intraoperative Specimen X-rays
• MarginProbe in selected cases

View Surgical Margins

What other steps may be taken to improve breast appearance after lumpectomy?

Dr. Holmes is an expert in oncoplastic surgery, an advanced approach to breast cancer surgery that utilizes plastic surgery procedures to improve cancer removal and breast appearance after lumpectomy.  For example, with oncoplastic surgery, breast cancer surgery can be combined with breast reduction or breast lifts of both breasts to improve breast appearance and symmetry.   Breast reductions and breast lifts are usually covered by insurance when performed at the time of a breast cancer operation or at a later date to restore breast shape or symmetry.  

For more information about breast cancer surgery, visit Dr. Holmes’s YouTube Channel here.