Understanding Lumpectomy Surgery

A breast cancer diagnosis can feel overwhelming, and many people assume that treatment always means removing the entire breast. This common belief often makes the situation seem more stressful than it may actually be.

However, breast cancer treatment has advanced significantly. In many cases, doctors can remove only the tumour along with a small amount of surrounding tissue while preserving most of the breast. This approach is known as breast-conserving surgery, also called a lumpectomy, and it is commonly recommended for certain early-stage cancers.

In this blog, we will explain how this surgery is performed, what the procedure involves, and what patients can expect during recovery.

What is a Lumpectomy?

Unlike a mastectomy, which removes the entire breast tissue, a lumpectomy removes only the malignant tumour along with a small amount of surrounding healthy tissue called a margin. This margin acts as a protective buffer to help ensure that no microscopic cancer cells remain at the tumour site while preserving the natural shape and appearance of the breast.

Since the surgery is less extensive than removing the entire breast, it is usually performed as an outpatient procedure, meaning most patients can return home the same day. 

What are the Types of Lumpectomy Procedures?

Lumpectomy is not a one-size-fits-all surgery. The exact procedure depends on factors such as the tumour’s size, location, and how much tissue needs to be removed while still preserving the breast. Based on these factors, surgeons may use different types of lumpectomy procedures to treat or diagnose breast cancer effectively.

Excisional biopsy

An excisional biopsy is usually performed when a suspicious lump is detected, but it needs confirmation. In this procedure, the surgeon removes the entire abnormal lump so it can be tested in a laboratory. If the lump is small and the surrounding tissue is clear of cancer cells, this surgery alone may completely remove the tumour.

Wide local excision

This is the most common type of lumpectomy. The surgeon removes the tumour along with a small margin of healthy tissue around it. Removing this extra tissue helps ensure that any nearby cancer cells are also taken out, lowering the risk of the cancer returning.

Quadrantectomy

A quadrantectomy is performed when the tumour is larger or located in a specific section of the breast. In this procedure, about one-quarter of the breast tissue is removed. Because more tissue is taken out, surgeons may reshape the remaining breast tissue to maintain a natural appearance.

Re-excision of margins

Sometimes, after the first surgery, tests show that cancer cells are present at the edges of the removed tissue. This is called positive margins. In such cases, a re-excision is done to remove additional tissue from the same area to ensure all cancer cells are cleared.

Who May Need a Lumpectomy?

Choosing the right surgery depends on medical factors and the patient’s preferences. While many patients prefer lumpectomy because it preserves most of the breast, doctors recommend it only when certain clinical conditions are met. Generally, a lumpectomy is considered suitable when:

• The malignancy is localised: The cancer is limited to one specific area of the breast and has not spread across multiple sections.
• Tumour-to-breast ratio is favourable: The tumour is small enough that removing it will not significantly affect the breast’s overall shape.
• Aesthetic viability: There is enough healthy tissue left so the surgeon can reshape the breast and maintain a natural appearance.
• Commitment to follow-up care: The patient is able and willing to undergo radiation therapy after surgery, which is usually required to reduce the risk of cancer returning.

When is a Lumpectomy Not Recommended?

• Multifocal or multicentric disease: If there are several tumours in different parts of the breast, removing them through a lumpectomy may be difficult and could increase the chance of leaving some cancer behind.
• Large tumour compared to breast size: When the tumour is too large for the size of the breast, removing it with a lumpectomy may significantly change the shape of the breast.
• Cancer spreading to nearby tissues: If the cancer has spread to the skin of the breast or the chest muscles underneath, a more extensive surgery may be needed.
• Aggressive types of breast cancer: Some types, such as inflammatory breast cancer, grow and spread quickly, so doctors usually recommend a full mastectomy.
• High genetic risk: People with certain genetic mutations like BRCA1 or BRCA2, or a strong family history of breast cancer, may choose a mastectomy to reduce the risk of cancer returning.
• Previous radiation treatment: If the breast has already received radiation in the past, it may not be safe to have radiation again, which is usually required after a lumpectomy.

How Should You Prepare for Lumpectomy Surgery?

Preparing for a lumpectomy involves both practical and medical steps. Since the procedure uses anaesthesia and is usually done as a day-care surgery, you will not be able to drive yourself home. It is important to arrange for a family member or friend to take you home and stay with you for the first 24 hours.

Before surgery, you will also discuss your current medications with your doctor. You may be asked to stop eating or drinking for several hours before the procedure, and some blood-thinning medicines or supplements may need to be paused for a few days to reduce the risk of bleeding.

What Happens During a Lumpectomy Surgery?

A lumpectomy is a carefully planned procedure that removes the tumour while preserving most of the breast. The surgery usually follows a few simple steps.

Step 1: Localisation and Marking

If the tumour is very small and cannot be felt, a radiologist uses imaging tests like ultrasound or mammography to find its exact location. A tiny wire or marker may be placed to guide the surgeon during the operation

Step 2: Giving Anaesthesia

Before the surgery begins, anaesthesia is given so you do not feel any pain. In most cases, general anaesthesia is used, which means you will be asleep during the procedure.

Step 3: Removing the Tumour

The surgeon makes a small incision in the breast and removes the tumour along with a small amount of healthy tissue around it. This helps make sure that no cancer cells are left behind.

Step 4: Placing Marker Clips

Tiny metal clips may be placed in the area where the tumour was removed. These clips help doctors target the exact area if radiation therapy is needed later.

Step 5: Closing the Incision

The internal tissues are brought together to maintain the breast’s shape, and the skin is closed with dissolvable stitches. These stitches are absorbed by the body over time, eliminating the need for a follow-up appointment for stitch removal.

Lymph node removal

During a lumpectomy, the surgeon may also remove one or two nearby lymph nodes from the underarm. This is called a sentinel lymph node biopsy. These nodes are checked to see if cancer cells have started to spread. The results help doctors understand the stage of the cancer and decide if further treatment is needed.

Reconstructive surgery

In many modern lumpectomies, surgeons use special techniques to reshape the remaining breast tissue after the tumour is removed. This helps maintain the natural contour of the breast and reduces the chances of dents or unevenness. As a result, the breast usually looks more natural after the surgery.

Recovery Time and Implications After Surgery

After a lumpectomy, the removed tumour and nearby lymph nodes are examined in a lab to check for cancer cells. These results help doctors decide the next steps in treatment.

• If no cancer is found in the lymph nodes and the tissue around the tumour is clear, it is called a negative margin, which is the best outcome.
• If cancer is found in the lymph nodes, additional tests or treatments may be needed.
• A positive margin means cancer cells are still present in the surrounding tissue, so another surgery may be required.
• Some cancer cells have special characteristics, such as hormone receptors, and in such cases, doctors may recommend treatments like hormone therapy.

What are the Risks of Lumpectomy Surgery?

A lumpectomy is generally safe, but like any surgery, it can have some possible risks. Knowing these complications can help you monitor your recovery and seek medical help if needed.

• Infection: There is a small risk of infection at the incision site. Symptoms like redness, warmth, swelling, or discharge should be reported to your doctor.
• Seroma: Sometimes, clear fluid may collect where the tumour was removed, creating a soft lump. It often goes away on its own, but may occasionally need to be drained.
• Haematoma: Blood may collect under the skin after surgery, causing swelling or discomfort.
• Radiation fibrosis: After radiation therapy, the breast tissue may feel firmer or tighter over time.
• Lymphedema: If lymph nodes are removed, swelling may occur in the arm or hand on the same side due to fluid buildup.
• Post-operative pain: Some patients may feel sharp pain, tingling, or numbness in the chest or underarm, which usually improves within a few weeks.

Wrapping Up

A lumpectomy is an effective treatment option for many early-stage breast cancers, as it removes the tumour while preserving most of the breast. With modern surgical techniques and proper follow-up care, many patients experience good outcomes and a quicker recovery compared to more extensive surgeries.

For NRIs, the cost of cancer treatment abroad can be very high, which is why many choose to seek treatment in India, where advanced care is available at comparatively affordable costs. Having the right coverage can make this journey smoother. Niva Bupa NRI Health Insurance helps provide financial protection for medical expenses in India, allowing patients to focus on treatment and recovery with greater peace of mind.

FAQs

Q1. Can you breastfeed after a lumpectomy?

Often, yes. Since a lumpectomy preserves most breast tissue and ducts, breastfeeding may still be possible. However, radiation therapy afterwards can reduce milk production in the treated breast.

Q2. What type of bra should be worn during recovery?

Doctors usually recommend a soft, front-closing, wire-free surgical bra or a supportive sports bra. It should be worn day and night for a few weeks to reduce movement, swelling, and irritation.

Q3. Does a lumpectomy cause permanent loss of sensation?

Temporary numbness or tingling around the incision is common. Sensation often returns within a few months, though small areas of permanent numbness may occur in some cases.

Q4. How does a lumpectomy affect future breast cancer screenings?

Regular mammograms are still essential. Surgeons place small marker clips during surgery to help radiologists distinguish scar tissue from potential abnormalities.

Q5. When does radiation therapy start after a lumpectomy?

Radiation typically begins 3–8 weeks after surgery, once healing has started. If chemotherapy is required, radiation usually begins after chemotherapy is completed.