What Should I Expect Before A Lumpectomy
The details of your case can affect how your breast looks after surgery. Your surgeon will review your imaging with the radiologist and design a surgical procedure which will focus on removing the entire cancer area.
In some cases, due to the larger size of the tumor, the breast surgeon may enlist the assistance of a plastic/reconstructive surgeon to perform combined team approach surgery called an oncoplastic lumpectomy. In an oncoplastic operation, the cancer is a bit bigger than suitable for a traditional lumpectomy , so the planned surgery takes into account the larger piece of breast tissue needing to be removed and allows for better scar placement, reshaping and nipple position. Often oncoplastic surgery requires a surgery on the other, normal breast to reduce the volume as well to match the cancer breast size.
Its important to talk with your healthcare provider before surgery about how your breast may change. Your provider can tell you what breast surgery options are available.
Your provider will go over procedure details before surgery to help you feel comfortable about your care. Ask your provider to explain anything you dont understand or are unsure about.
Its important for your health and safety that you follow all of your providers instructions, such as when to stop taking certain medications before surgery.
What Support Does Msk Offer To Women Recovering From A Lumpectomy
MSKs quality-of-life specialists provide comprehensive follow-up care to help you recover from a lumpectomy. Many services are available at our New Jersey, Long Island, and Westchester County locations as well as at our Evelyn H. Lauder Breast Center in Manhattan.
- Wellness therapies from integrative medicine specialists can relieve emotional or physical symptoms after surgery or for potential side effects.
- Rehabilitation and exercise therapies can help you heal and recover your strength, flexibility, and stamina.
- Find emotional support through our Counseling Center, online support groups, or patient-to-patient support program, which connects you with other breast cancer survivors who understand your challenges and concerns. Our social workers are available across our treatment locations to provide emotional support and guidance. They can also help with some of the practical aspects of having cancer, such as transportation assistance and the impact on your job.
Delay In Surgery And Tumor Growth: Her2 And Triple Negative Tumors
The optimal time between diagnosis and surgery can also be looked at from the standpoint of tumor growth, although the doubling rate varies between different tumors.
A 2016 study, though it didn’t look at survival, did evaluate the growth rate of breast cancers during wait time for surgery by ultrasound measurements. In this study, the average wait time between diagnosis and surgery was 31 days .
The average diameter and volume of tumors at diagnosis was 14.7 millimeters and 1.3 centimeters vs. 15.6 millimeters and 1.6 centimeters.
The growth rate of different tumors based on receptor status, however, was very different:
- Triple-negative tumors: 1.003 percent growth each day
- HER2 positive tumors: 0.850 percent growth each day
- Luminal B/A tumors : 0.208/0.175 percent growth each day
As noted, tumors that were triple negative or HER2 positive grew much faster. This was also linked to an increase in stage based on size between diagnosis and surgery, with 18 percent of triple-negative tumors increasing versus only 2 to 3 percent of estrogen receptor positive tumors changing. Since stage is linked with survival rates, this study also supports earlier surgery, especially for people with triple negative or HER2 positive tumors.
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Was All The Cancer Removed
During BCS, the surgeon will try to remove all the cancer, plus some surrounding normal tissue. This can sometimes be difficult depending on where the cancer is located in your breast.
After surgery, a doctor, called a pathologist, will look closely at the tissue that was removed in the lab. If the pathologist finds no invasive cancer cells at any of the edges of the removed tissue, it is said to have negative or clear margins. For women with DCIS, at least 2mm of normal tissue between the cancer and the edge of the removed tissue is preferred. If DCIS cancer cells are found near the edges of the tissue , it is said to have a close margin. If cancer cells are found at the edge of the tissue, it is said to have a positive margin.
Having a positive margin means that some cancer cells may still be in the breast after surgery, so the surgeon often needs to go back and remove more tissue. This operation is called a re-excision. If cancer cells are still found at the edges of the removed tissue after the second surgery, a mastectomy might be needed.
Why Are Lumpectomies Performed
A lumpectomy is performed for patients who are diagnosed with breast cancer. It’s a form of treatment that may be a good option in the early stages of cancer. The goal of this surgery is to prevent cancer from spreading to the rest of the body.
Many patients decide to have a lumpectomy because they want to keep as much of their breast as possible. Its less invasive than a mastectomy, but patients who have a lumpectomy also need to have radiation therapy or another treatment.
When compared with a mastectomy, your chances of long-term survival can be the same with a lumpectomy followed by radiation if:
- You have a small cancer in only one breast, or cancers that are close together and can be treated at the same time
- Your margins are clear
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Talking With Your Doctor About Breast Surgery Options
Maintaining open and honest communication with your doctor is an important part of your care. In fact, research has shown that people who have a good relationship with their doctor tend to be more satisfied with the care they receive. However, starting some conversations can be difficult. So to get the ball rolling, the Cancer.Net Blog has created this new series that will ask doctors to share their tips and insights for discussing a number of potentially sensitive or difficult subjects that might come up during diagnosis, treatment, and follow-up care.
As you may have seen during our coverage of the 2014 Breast Cancer Symposium, researchers continue to learn more about the outcomes of various surgical options for early-stage breast cancer. To get a better understanding of these options and find out more about the decision-making process, I talked with ASCO member Deanna Attai, MD, FACS, a board-certified surgeon practicing in Southern California. Dr. Attai is also President-Elect of the American Society of Breast Surgeons.
Q: What surgical options do women diagnosed with early-stage breast cancer have?
Q: What are the advantages and disadvantages for having a lumpectomy followed by radiation therapy?
Q: What are the advantages and disadvantages of having a mastectomy?
Radiation Therapy After Lumpectomy
Radiation therapy is usually given after lumpectomy to get rid of any cancer cells that might be left in the breast. These cells are too small to see on mammograms or other imaging tests, or to measure with lab tests.
Radiation therapy can lower the risk of :
- Breast cancer recurrence
- Breast cancer death
If lumpectomy and mastectomy are both options for surgery, survival with lumpectomy plus radiation therapy is the same as with mastectomy .
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Survival And Time To Surgery
A 2016 study published in JAMA Oncology looked at data from over 115,000 people via the National Cancer Database . This study included people age 18 and older who were cared for at Commission on Cancer-accredited cancer centers across the United States.
All of the people had early stage breast cancer with surgery as their first treatment. They then looked at wait times to surgery and survival rates at five different intervals: a wait of less than 30 days, a wait time of 31 to 60 days, a wait time of 61 to 90 days, a wait time of 91 to 120 days, and a wait time of 121 to 180 days.
They found that for each 30-day interval of delay, survival rates decreased for people with stage I and stage II breast cancer. The conclusion was that although time is needed to discuss treatment options and prepare, earlier surgery is better.
Getting Your Pathology Results After Lumpectomy
In the days after the lumpectomy surgery, youll receive a pathology report. This report will explain the characteristics of the breast cancer, such as:
cell grade: how closely the cancer cells resemble normal, healthy cells
hormone receptor status: whether or not the breast cancer cells have receptors for the hormones estrogen and progesterone, which means these hormones are signaling the cancer to grow
HER2 status: whether the cells have too many copies of the HER2 gene, which can promote cancer cell growth
These and other characteristics of the breast cancer will help you and your doctor decide on the best treatment plan for you.
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Breast Reconstruction Surgery After Breast
Before your surgery, talk to your breast surgeon about how breast-conserving surgery might change the look of your breast. The larger the portion of breast removed, the more likely it is that you will see a change in the shape of the breast afterward. If your breasts look very different after surgery, it may be possible to have some type of reconstructive surgery or to have the size of the unaffected breast reduced to make the breasts more symmetrical . It may even be possible to have this done during the initial surgery. It’s very important to talk with your doctor before the cancer surgery to get an idea of how your breasts are likely to look afterward, and to learn about your options.
What Happens During Breast Surgery
Breast surgeries are very complicated, but the steps are simplified here with two examples: breast augmentation surgery and breast reduction surgery.
There are five steps in a breast augmentation surgery:
There are five steps in a breast reduction surgery:
- Anesthesia. General anesthesia.
- Incision. It will be around your nipple, then downward below your breast.
- Removal. Extra skin, tissue and fat are removed.
- Relocation. Your nipple will be relocated to a more ideal location.
- Close the incisions. Your healthcare provider may install a drainage tube at the incision site. Dressings will be applied.
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Looking After Your Drains And Wound
When you leave hospital follow any instructions you are given about caring for your wound. This will vary from hospital to hospital and depends on the kind of surgery you have.
If youre discharged with your drains still in place, they may be regularly checked at home by a nurse or you may be asked to telephone or return to the hospital each day so that the drainage can be checked. This may sound frightening, but if your treatment team suggests it, they will give you all the information and support you need.
You can usually bathe and shower normally following surgery , but its advisable not to use any soaps or deodorant products on or around the area of your wound. The nursing staff on the ward will give you specific advice on caring for your wound and any dressings. They will also make any arrangements for the removal of your stitches if they are not dissolvable.
If you have questions about caring for your wound, or what kind of follow-up care youll receive, contact your breast care nurse or another member of your specialist team.
Breast Reconstruction After Surgery
Many woman having surgery for breast cancer might have the option of breast reconstruction. A woman having a mastectomy might want to consider having the breast mound rebuilt to restore the breasts appearance after surgery. In some breast-conserving surgeries, a woman may consider having fat grafted into the affected breast to correct any dimples left from the surgery. The options will depend on each womans situation.
There are several types of reconstructive surgery, but your options depend on your medical situation and personal preferences. You may have a choice between having breast reconstruction at the same time as the breast cancer surgery or at a later time .
If you are thinking about having reconstructive surgery, its a good idea to discuss it with your breast surgeon and a plastic surgeon before your mastectomy or BCS. This gives the surgical team time to plan out the treatment options that might be best for you, even if you wait and have the reconstructive surgery later.
To learn about different breast reconstruction options, see Breast Reconstruction Surgery.
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Why Should I Get Radiation After Surgery
Most people have radiation treatments after lumpectomy surgery to destroy any remaining microscopic cancer cells. This combination is a standard treatment option for women with breast cancer. . It effectively treats cancer while preserving more of how your breast looks and feels.
Research has shown lumpectomy plus radiation offers long-term survival rates that are similar to those who have a mastectomy .
Wire Localization To Guide Surgery
Sometimes, if the cancer in your breast cant be felt, is hard to find, and/or is difficult to get to, the surgeon might use a mammogram or ultrasound to guide a wire to the right spot. This is called wire localization or needle localization. If a mammogram is used you may hear the term stereotactic wire localization. Rarely, an MRI might be used if using the mammogram or ultrasound is not successful.
After medicine is injected into your breast to numb the area, a mammogram or ultrasound is used to guide a thin hollow needle to the abnormal area. Once the tip of the needle is in the right spot, a thin wire is put in through the center of the needle. A small hook at the end of the wire keeps it in place. The needle is then taken out. Once in the operating room, the surgeon uses the wire as a guide to find the part of the breast to be removed.
The surgery done as part of the wire localization may be enough to count as breast-conserving surgery if all of the cancer is taken out and the margins are negative. If cancer cells are found at or near the edge of the removed tissue , more surgery may be needed.
It should be noted that a wire-localization procedure is sometimes used to perform a surgical biopsy of a suspicious area in the breast to find out if it is cancer or not.
There are other ways a surgeon can be guided to the tumor, but these techniques are newer and not used in every facility.
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Time To Treatment With Metastatic Breast Cancer
There is little research looking at the optimal time until treatment for metastatic breast cancer, though it appears that waiting more than 12 weeks has been linked with lower survival. In general, however, the goal of treatment with MBC is different than early stage disease. For most people, treatment for early-stage disease is aggressive, with the goal to reduce the risk of recurrence. With MBC, the goal is often to use the least amount of treatment necessary to control the disease.
Surgery To Remove Nearby Lymph Nodes
To find out if the breast cancer has spread to underarm lymph nodes, one or more of these lymph nodes will be removed and looked at in the lab. This is important to figuring out the stage of the cancer. Lymph nodes may be removed either as part of the surgery to remove the breast cancer or as a separate operation.
The two main types of surgery to remove lymph nodes are:
- Sentinel lymph node biopsy is a procedure in which the surgeon injects a dye and then removes only the lymph node under the arm that have taken up the dye. These lymph nodes are where the cancer would likely spread first. Removing only one or a few lymph nodes lowers the risk of side effects that can happen after an axillary lymph node dissection , such as arm swelling that is also known as lymphedema.
- Axillary lymph node dissection is a procedure that does not use a dye and in which the surgeon removes many underarm lymph nodes. ALND is not done as often as it was in the past, but it might still be the best way to look at the lymph nodes in some situations.
To learn more about these procedures, see Lymph Node Surgery for Breast Cancer.
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What To Bring To The Hospital
Recommended items to bring with you to stay in the hospital include:
- Personal items, such as a toothbrush, toiletries, pillow, earplugs
- Slippers and extra socks
UCSF Health medical specialists have reviewed this information. It is for educational purposes only and is not intended to replace the advice of your doctor or other health care provider. We encourage you to discuss any questions or concerns you may have with your provider.