Q: What are the pros and cons of a lumpectomy?

Pros Lumpectomy can preserve much of the breast tissue, appearance, and sensation. The surgery is less invasive than a mastectomy, so recovery is easier and shorter. Research suggests that the survival rate with lumpectomy and radiation for early-stage breast cancer (stage I or stage II) is slightly better than with mastectomy only or mastectomy and radiation. Cons Although it is “breast-conserving,” the surgery may still change the look of your breast or cause significant asymmetry between your two breasts. A lumpectomy is not a complete breast cancer treatment. If you have a breast cancer diagnosis, your doctor will most likely recommend additional therapies. Even when all cancer is removed during a lumpectomy, radiation treatment follows in most cases, to ensure no cancer cells remain.

Question 1

What is a lumpectomy?

Accepted Answer

A lumpectomy is a surgical procedure that removes a cancerous or benign lump of abnormal tissue from the breast, along with a small amount of normal tissue around it. The goal is to remove all cancer or abnormal tissue without compromising the appearance of the breast. It’s sometimes called breast-conserving surgery, a wide local excision, quadrantectomy, partial mastectomy, or segmental mastectomy.

If a biopsy indicates you have cancer that’s small (4 cm or less) and early-stage, your doctor may recommend a lumpectomy over a mastectomy (removal of the entire breast), to remove the cancerous tissue. “The patient's cancer must meet certain criteria in order to qualify for this procedure, like being below a certain size and located in just one section of the breast,” says Dr. Lisa F. Schneider, a New York City plastic surgeon who specializes in reconstructive surgeries.

A lumpectomy is often followed by radiation therapy and, possibly, chemotherapy, hormone therapy, or targeted therapy, to ensure that all cancer cells have been eliminated.

You can also have a benign breast tumor surgically removed, if it’s causing pain or other symptoms.

Question 2

What are the pros and cons of a lumpectomy?

Accepted Answer

Pros

Lumpectomy can preserve much of the breast tissue, appearance, and sensation.
The surgery is less invasive than a mastectomy, so recovery is easier and shorter.
Research suggests that the survival rate with lumpectomy and radiation for early-stage breast cancer (stage I or stage II) is slightly better than with mastectomy only or mastectomy and radiation.

Cons

Although it is “breast-conserving,” the surgery may still change the look of your breast or cause significant asymmetry between your two breasts.
A lumpectomy is not a complete breast cancer treatment. If you have a breast cancer diagnosis, your doctor will most likely recommend additional therapies. Even when all cancer is removed during a lumpectomy, radiation treatment follows in most cases, to ensure no cancer cells remain.

Question 3

How much does a lumpectomy cost?

Accepted Answer

Your out-of-pocket cost will depend on the location and experience level of your doctor, how extensive the surgery is, what type of anesthesia is used, and how much of your procedure is covered by your health insurance.

Under the Women’s Health and Cancer Rights Act of 1998, health insurance, including Medicare, is legally required to pay for lumpectomy and reconstructive surgeries for breast cancer patients. However, there may be out-of-pocket or coinsurance costs.

Question 4

What happens during a lumpectomy?

Accepted Answer

Lumpectomy is an outpatient surgery, so you’ll go home the same day. The procedure takes 15–40 minutes, and it’s usually performed with local anesthesia to numb the area and a sedative to relax you (rather than general anesthesia, which makes you completely asleep).

Your surgeon will first mark the area to be removed, locating it with ultrasound or a mammogram, if needed. Using an electrosurgical scalpel that employs heat to minimize bleeding, they’ll make a curved incision that follows the shape of your breast (to encourage proper healing). They’ll try to hide the incision in the edge of the areola, in your armpit, or under the breast in order to minimize the appearance of a scar.

The breast lump, along with a rim of healthy surrounding tissue, will be removed and sent to a pathologist to be biopsied. In some cases, the surgeon also removes axillary lymph nodes in the armpit to be biopsied as well (this is called a sentinel lymph node biopsy because these nodes are the first place cancer is likely to spread). The incision will be stitched closed and a dressing applied.

A pathologist will examine the removed tissue under a microscope and determine whether the edges of tissue around the tumor (known as the margins) contain cancer cells. If all the cancer was removed, the pathology report will say that the surgical margins are clear or clean. If cancer cells are detected, it’s said to have positive margins, and you may need an additional operation to remove more tissue.

Question 5

How long does it take to recover from a lumpectomy?

Accepted Answer

Your lumpectomy recovery time will depend on the extent of your breast surgery and whether lymph nodes were removed, but you can plan on at least two to three days of downtime. To ease discomfort, your doctor may prescribe pain medication or recommend an over-the-counter pain reliever. Rest and wear a supportive surgical bra that minimizes movement.

Your surgeon may have placed surgical drains to collect fluid. Those will stay in place for a week or two before being removed at a follow-up appointment, and you’ll need to empty them a few times a day, recording the fluid levels.

To prevent stiffness and preserve your range of motion, your doctor or a physical therapist will recommend arm exercises, to begin the day after surgery. Depending on the extent of your surgery, you may be able to resume normal activity within a week.

Your breast may feel numb or tender for a few months, though the sensations should subside with time. You may also feel hardened scar tissue along the incision site, but it should soften over several months.

You may also notice that another lump appears in the same spot where the original lump was. “We warn patients that a lump after surgery or biopsy is completely normal and temporary. It can be for one of two reasons: blood blister (hematoma) formation or healthy tissue inflammation. Both conditions make a tough, slightly tender knot, and both situations resolve over weeks to months, depending on how large they are,” explains Dr. Heather Richardson, a general surgeon in Beverly Hills, California.

Question 6

What are the risks and potential side effects of a lumpectomy?

Accepted Answer

There is a risk of developing a painful seroma or a hematoma where the tissue has been removed, especially if a surgical drain wasn’t placed at the end of your procedure. A seroma is a buildup of clear plasma and inflammatory fluid, while a hematoma is a collection of blood. Your doctor can remove the fluid via a suction tube, though they may need to install a temporary drain. They may also inject the area with antibiotics, to reduce the volume of fluid.

Post-mastectomy pain syndrome, a chronic neuropathic pain disorder, can affect women who’ve had a lumpectomy, though the chance of injury increases with the extensiveness of the surgery. You may experience pain, numbness, or itchiness from nerve damage that resolves on its own as nerves regrow, but uncomfortable sensations may persist.

Question 7

How might a lumpectomy affect the appearance of your breast?

Accepted Answer

Prior to the procedure, you’ll want to discuss with your lumpectomy surgeon and a reconstructive surgeon how the surgery could change the look of your breast. “The considerations are different for a woman who wears an A cup versus a woman who wears a G cup,” says Dr. Schneider.

In many cases, lumpectomy causes minimal scarring or changes to the breast. Still, if it does, you will have options for restoration, whether to fill an indentation or achieve symmetry between the two breasts.

Question 8

What are your options for breast reconstruction after a lumpectomy?

Accepted Answer

“The majority of women with breast cancer in this country are having lumpectomies for their breast cancer surgery, but many don’t know there are good reconstruction options for lumpectomies too,” says Dr. Ann Peled, a plastic surgeon in San Francisco who specializes in breast reconstruction. “Even a breast reduction or breast lift falls into that reconstruction category, in this context. Sometimes women think they want to have a mastectomy, but when they hear that they could have a lumpectomy combined with a lift, they realize that might be a better choice for them.”

Your natural breast size and cancer treatment plan will largely influence your lumpectomy outcome and reconstruction options.

“If your breasts are small, a lumpectomy may remove a large portion of your breast. This, combined with the radiation, can create a real asymmetry or difference between your two breasts. In this case, a mastectomy and reconstruction may be a better option, especially if it allows you to potentially avoid radiation,” says Dr. Schneider.

“On the other hand, if your breasts are large, the plastic surgeon can work together with the breast surgeon to perform a breast reduction at the same time. The breast surgeon takes out the lumpectomy specimen, and then the plastic surgeon rearranges the breast to create a lifted breast with an improved shape. The plastic surgeon will also reduce the other breast, to match the lumpectomy side.”

In a 2015 review of studies and clinical trials called “De-Mythifying Breast Reconstruction,” Dr. Schneider and coauthor Dr. Babak Mehrara wrote, “Breast reconstruction might not be the right choice for every patient, but every patient deserves to have a complete discussion before cancer treatment, to make a fully informed decision. The more involved they are in the decision process, the more likely they are to be satisfied with postoperative outcomes.”

Related: 5 Things You Need to Know About Your Breast Reconstruction Options

Question 9

Sources & studies

Accepted Answer

Agarwal, Shailesh, et al. “Effect of Breast Conservation Therapy vs Mastectomy on Disease-Specific Survival for Early-Stage Breast Cancer.” JAMA Surgery, vol. 149, no. 3, Mar. 2014.

Schneider, Lisa F., and Babak J. Mehrara. “De-Mythifying Breast Reconstruction: A Review of Common Misconceptions about Breast Reconstruction.” Journal of the American College of Surgeons, vol. 220, no. 3, Mar. 2015.

The Center for Consumer Information & Insurance Oversight. “Women's Health and Cancer Rights Act (WHCRA).” CMS, Centers for Medicare & Medicaid Services, 4 May 2013.

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Lisa F. Schneider, MD

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Lisa F. Schneider, MD

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Lisa F. Schneider, MD

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