Lumpectomy Surgery in Delhi, India

A lumpectomy is a procedure to remove cancer or other abnormal tissue from the breast. During a lumpectomy, the surgeon removes cancerous or other abnormal tissue along with a small amount of the healthy tissue underneath it to ensure that the entire abnormal tissue is excised.

A lumpectomy is also called a breast conservation procedure. It is so because only a portion of the breast is removed, unlike a mastectomy, where all of the breast tissue is removed. It may also be referred to as an excisional biopsy or quadrantectomy. It is the treatment of choice for early-stage breast cancer. It may also be carried out to rule out a cancer diagnosis. This treatment is usually followed by radiotherapy to reduce the chances of recurrence.

When is Lumpectomy Surgery Needed?

Doctors may recommend a lumpectomy if a biopsy has shown a positive sign of cancer and the tumour is believed to be small and at an early stage. A lumpectomy may also be used to remove specific noncancerous or precancerous breast abnormalities.

Who are the Candidates for Lumpectomy Surgery?

Lumpectomy is advised for women with newly diagnosed and early-stage breast cancers. Early-stage breast cancer includes:

• Stage I breast cancer
• Stage II breast cancer
• DCIS or Ductal Carcinoma in situ

Other factors that determine a good candidate for lumpectomy are:

• The size of the tumour is smaller than the breast size
• The tumour involves only a single area of the breast
• Radiation treatments can be received after lumpectomy

Who should not Consider Surgery?

The doctor may not recommend lumpectomy for breast cancer for patients with:

• A history of scleroderma hardens the skin and other tissues, making healing difficult after a lumpectomy.
• A history of systemic lupus erythematosus or SLE; this inflammatory condition has ill effects on radiation therapy.
• Two or more tumours in different quadrants of the breast that cannot be removed with a single incision. This could affect the appearance of the breast.
• A history of radiation therapy to the breast area would make future radiation treatments riskier.
• Widespread breast cancer covering most of the breast area requiring a mastectomy and not a lumpectomy.
• A large tumour and small breasts, making the lumpectomy unaesthetic.
• No access to radiation therapy.

Diagnosis

The tests and procedures that may be used to diagnose breast cancer are:

• Breast exam: The doctor assesses the breast and lymph nodes in the armpit. They try to locate any kinds of lumps or any other abnormalities.
• Mammogram: An X-ray of the breast screens for breast cancer. It is one of the most important tests carried out for the diagnosis of breast cancer.
• Breast ultrasound: This technique utilises sound waves to produce images of the breast, advised to determine if a new lump in the breast is a fluid-filled cyst or a firm mass.
• Biopsy: A biopsy helps confirm the diagnosis of breast cancer. A specialised needle is guided by an imaging test, like an X-ray, for the biopsy to take a tissue core from the suspected area. A tiny metal marker is left at the suspected location within the breast to identify the site for future imaging tests.
• Breast Magnetic Resonance Imaging (MRI): An MRI machine uses magnetic and radio waves to create images of the breast's interior. Before a breast MRI, a dye is injected for contrast imaging. Unlike other imaging tests, MRIs do not use radiation to create images.

Preparing for Lumpectomy Surgery

At the presurgical consultation visit, the benefits and risks of surgery are discussed. Additionally, a list of presurgical restrictions and other instructions to follow is given. A lumpectomy is an outpatient procedure. Therefore, a proper medical history should be given to the doctors at this appointment. In general, it is recommended to follow the given instructions, such as:

• Prior consent from the physician is required to stop taking aspirin or any other blood-thinning medication before the procedure. This reduces the risk of bleeding.
• Avoid eating 8 to 12 hours before surgery, especially if general anaesthesia administration is scheduled. This prevents postoperative nausea and vomiting.
• It is crucial to take someone along for the surgery since they can provide support and assist with the postoperative instructions, as it may take several hours for the effects of the anaesthesia to wear off.

Procedure details

Locating the area to be removed

Localising the lump in the breast is essential. Only the suspect, along with some normal surrounding tissue, is excised. The lumpectomy begins with localising the lesion using imaging or ultrasound techniques. If the lump can be felt by palpation, localisation may not be required. Once the position of the tumour is assessed, the lump can be easily removed.

Preparing for lymph node excision

The operating surgeon may recommend the removal of affected lymph nodes in the armpit or close to the lump in the breast. Surgery to excise a few lymph nodes by Sentinel Node Biopsy procedure is recommended for early-stage breast cancer. If the surgeon feels that the cancer has metastasised, removal of several lymph nodes may be indicated.

Some of the lymph node removal procedures are:

• Sentinel node biopsy
• Axillary lymph node dissection

During the procedure

A lumpectomy is performed under general anaesthesia by sedating the patient. The surgeon makes an incision over the tumour or the area containing the wire or radioactive seed to remove cancer along with part of the surrounding healthy tissue. The excised tissue is then sent for biopsy.

A similar procedure is followed for sentinel node biopsy or axillary lymph node dissection. Incisions are sutured with care to preserve the healthy breast tissue.

Possible Complications

Some complications of lumpectomies include:

• Bleeding
• Infection
• Formation of hard scar tissue at the operated site
• A change in the shape and appearance of the breast due to the removal of a large portion of the breast.
• Temporary swelling called lymphedema in the arm or hand
• Bruising
• Pain
• Tenderness

Every surgery carries some amount of risk. Though lumpectomy is a common procedure that offers a high level of safety and effectiveness, it still has some potential complications. It is less invasive than mastectomy, in which the entire breast needs to be removed.

Care After Lumpectomy Surgery

The patient stays in the recovery room after surgery. All vitals are monitored. For patients who have undergone outpatient surgery, they are discharged once their condition is stable. For patients with axillary lymph node dissection, a hospital stay of a day or two is advised.

Some other elements to be expected are:

• A dressing over the surgical site.
• Mild pain, numbness, and a pinching sensation in the underarm area.
• Following post-surgical care instructions such as caring for the incision, timely dressing, and recognising the signs of infection.
• Prescriptions for pain and infection (antibiotics).
• Some restrictions on routine activities till the wounds heal.
• A follow-up appointment 7-14 days after surgery.

Review

Reviewed By Dr. Aditi Chaturvedi, Senior Consultant - Cancer Care / Oncology, Surgical Oncology, Breast Cancer on 4 July 2024