Locating the area to be removed
Your lumpectomy procedure begins with locating the area of your breast that contains the abnormality.
If your breast abnormality was detected on a mammogram and confirmed with a biopsy, your radiologist may have placed a tiny marker or clip in your breast during the biopsy. If this is the case, a thin wire or radioactive marker may be inserted in your breast just before surgery and passed down to the marker or clip. Your surgeon can use the wire as a guide to the precise area that needs to be removed during surgery.
If you have a lump or mass in your breast that can be easily felt through the skin, the wire procedure may not be necessary because the surgeon can more easily find the abnormal area to be removed.
Preparing for lymph node removal
Lymph nodes are often removed during surgery to determine whether cancer has spread beyond the breast. Options may include:
- Axillary node dissection. During this procedure, the surgeon removes a number of lymph nodes from your armpit on the side of the tumor. Your surgeon may recommend this procedure if a lymph node biopsy done before surgery shows signs of cancer.
Sentinel lymph node biopsy. During this procedure your surgeon removes only the first one or two nodes into which a tumor drains (sentinel nodes). These are then tested for cancer. Your doctor may recommend this procedure if there are no concerns about enlarged lymph nodes prior to your surgery.
Before your surgery, a radioactive substance or blue dye or both is injected into the area around the tumor or the skin above the tumor. The dye travels to the sentinel node or nodes, allowing your surgeon to identify and remove them.
If no cancer is present, no further lymph nodes need to be removed. If cancer is present, the surgeon will discuss options, such as receiving radiation to the armpit to treat the affected lymph node. If this is what you decide to do, you will not need to have more lymph nodes in the armpit removed.
During the procedure
A lumpectomy is usually performed using general anesthesia, which will make you unaware during the procedure.
Your surgeon will make an incision over the tumor or over the area that contains the wire, remove the tumor and some surrounding tissue, and send it to the lab for analysis. He or she will do the same for the sentinel lymph node or nodes if you're having a sentinel node biopsy or the axillary lymph nodes if you're having an axillary node dissection.
The surgeon will then close the incisions with attention to preserving the appearance of your breast, using stitches (sutures) that will either dissolve on their own or be removed later by your doctor.
After the procedure
After your surgery, you'll be taken to a recovery room. During this time, your blood pressure, pulse and breathing will be monitored.
If you've had outpatient surgery — usually lumpectomy and sentinel node biopsy — you'll be released when your condition is stable.
If you've had axillary node excision, you may need to stay in the hospital for a day or two if you're experiencing pain or bleeding.
Expect to have:
Oct. 23, 2014
- A dressing (bandage) over the surgery site
- Some pain, numbness and a pinching sensation in your underarm area
- Written instructions about post-surgical care, including caring for the incision and dressing, recognizing signs of infection
- Prescriptions for pain medication and possibly an antibiotic
- Some restrictions of activity
- A follow-up appointment with your doctor, usually seven to 14 days after surgery
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- Townsend CM Jr, et al. Sabiston Textbook of Surgery: The Biological Basis of Modern Surgical Practice. 19th ed. Philadelphia, Pa.: Saunders Elsevier; 2012. https://www.clinicalkey.com. Accessed June 18, 2014.
- Surgery for breast cancer. American Cancer Society. http://www.cancer.org/cancer/breastcancer/detailedguide/breast-cancer-treating-surgery. Accessed Sept. 14, 2014.
- Pruthi S (expert opinion). Mayo Clinic, Rochester, Minn. Sept. 17, 2014.
- Sabel MS, et al. Breast conserving therapy. http://www.uptodate.com/home. Accessed Sept. 14, 2014.