Lumpectomy - breast-conserving surgery

The aim of breast conserving surgery (‘lumpectomy’) is to safely remove the cancer, keeping a breast shape that is acceptable to you. This procedure is also referred to as partial mastectomy or wide local excision.

Knowing what to expect before and after surgery can help you prepare. If you have any questions, talk to your breast surgeon or breast care nurse.

About the procedure

The operation usually takes up to 90 minutes. You may need to arrive at hospital earlier to prepare or to have scans.

The surgeon removes the tumour from the breast. They also remove some additional tissue around the tumour, called a ‘margin’. The aim is to make sure all the cancer is removed.

They will leave as much breast tissue as they can, to keep your breast close to its normal size and shape. The amount of tissue removed is different for each person and depends on the size of the tumour.

The surgeon will also remove one or more lymph nodes from your armpit to check for breast cancer cells. This procedure is a sentinel lymph node biopsy.

When the surgery is over, you will need time to recover from the general anaesthetic.

Testing the tissue after surgery

The surgeon sends the breast tissue and lymph nodes to a pathologist. The results will guide what other treatments your team recommend for you.

If the pathologist finds cancer cells in the margin, it means the cancer was not all removed and the margins were not 'clear'. 
You may need:

• another surgery to remove more tissue and create a clear margin
• a mastectomy to remove the all of the breast tissue.

Radiotherapy after breast conserving surgery

After breast conserving surgery for early breast cancer, radiotherapy (‘radiation therapy’) is recommended for most people. This is proven to be as effective in terms of survival as mastectomy for most people with early breast cancer.

Side effects of breast conserving surgery

Side effects might happen straight after surgery or later on. Always talk to your doctors or nurse if you are worried. It is possible to manage most side effects with the right care.

Common side effects

Common side effects of breast conserving surgery are:

• pain and discomfort in the breast or armpit while the wounds are healing. This usually settles after a few weeks.
• bruising or swelling around the wound in your breast (and under your arm if you had lymph nodes removed). Do not use ice packs or heat packs to reduce swelling unless your treating surgeon tells you to.
• tingling, numbness in your breast or armpit due to nerves being damaged. This usually improves with time.
• stiffness in your arm or shoulder. Ii is important you do the exercises recommended for you, to improve your range of movement.

Less common side effects

Less common side effects of breast-conserving surgery may include:

• pain or discomfort for a year or more after surgery. Talk to your treating team if you have ongoing or persistent discomfort.
• fluid (‘seroma’) in the area where tissue was removed from your breast or armpit (‘axilla’). Usually a small amount of fluid will settle and the body will reabsorb it over time. A surgeon, breast care nurse or radiologist needs to drain it.
• swelling (‘lymphoedema’) in the arm, hand, breast or chest on the side of the surgery. It is more common when several or many lymph nodes are removed from the armpit. Lymphoedema can develop months or even years after surgery. This can lead to complex issues if not treated. 
• wound infection – contact your doctor straight away if you have any signs of wound infection such as:
  
  • the wound is red, swollen or warm to touch
  • you feel generally unwell and have a fever.

What your breast may look like

You may have a dent (‘indentation’) where the tissue was removed, and a scar. These will become less noticeable over time.

How your breast or breasts look after surgery will depend on:

• where the breast tumour was
• how much breast tissue was removed.

For example, if the surgeon removes a large area of tissue, sometimes they can reshape the breast at the same time. They use oncoplastic techniques to fill the space.

The shape and size of one breast may be different to the other. To make both breasts looks the same shape and size, you may choose:

• further surgery (see Options for breast symmetry)
• use a partial external breast prosthesis in your bra. Ask your breast care nurse about BCNA's free My Care Kit. It contains a special post-surgery bra with a soft insert while you recover and consider options about breast symmetry.

Ask your surgeon to show you pictures of other people who have had breast conserving surgery, so you know what to expect.