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Care of the Breast Cancer Patient

Lumpectomy

Breast Cancer Surgery
Surgery is usually the first choice of treatment for breast cancer. In the past, most women were treated by a radical mastectomy - the removal of the entire breast and muscles of the chest. Surgical techniques have been refined and studies have shown that it is now possible and safe to conserve most of the breast while treating a breast cancer. In fact, in our practice approximately 70 percent of women undergo breast conserving treatments like lumpectomy, rather than mastectomy - far more than the national rate. Evidence shows that lumpectomy followed by radiation therapy is likely to be equally effective as mastectomy in most women. Your surgeon will advise you as to whether this is an appropriate option for your treatment.

Standard Treatments for Breast Cancer
Lumpectomy/Breast Conserving Surgery
Mastectomy
Mastectomy with immediate or delayed reconstruction

What is a lumpectomy?
A lumpectomy (also known as a partial or segmental mastectomy) is the surgical removal of a breast lump or abnormal area seen on a mammogram. When removing the lump, a small amount of surrounding normal tissue is also removed. This is done to make sure that all the cancerous tissue has been removed. The tissue is then examined by a pathologist to see if any of the cancer cells are present in the surrounding tissue. If there are no cancer cells present, this is called a "clean margin". If cancer cells are present in the surrounding tissue, your surgeon will recommend additional steps, which may include a re-excision to remove additional tissue in an attempt to clear the margins. The goal is to achieve removal of all cancer cells with the best cosmetic result possible when performing breast conservation surgery.

Most often your surgeon will also do a sentinel lymph node procedure or axillary (underarm) dissection at the same time. Lymph node dissection is done through a separate incision under your arm. This is done to determine whether any of the cancer cells have spread to the lymph nodes.

Lumpectomy with needle-localization for non-palpable lumps
If your surgeon cannot feel the lump to be removed, the radiologist will be asked to insert a guide wire into your breast prior to surgery to pinpoint the area of concern. If you require this procedure, on the day of your surgery you will begin your day in the radiology department. The radiologist or breast surgeon will then use mammography or ultrasound to insert a thin wire to be left in place for surgery as a guide for your surgeon to locate the area of the abnormality. The wire is then covered with a dressing to hold it in place. The average time for this procedure is 30-50 minutes. You are then taken to the operating room where you will receive a local anesthetic to numb your breast, as well as general anesthesia to make you sleep through the procedure. The surgeon uses the wire as a guide to locate the lump. An incision (cut) is made and the abnormal tissue as well as the wire is removed. When the surgery is completed, a dressing is placed over the incision and you are taken to the recovery area to recover. In general, you can expect to be in the operating room for 30-90 minutes and in recovery for 1-2 hours.

What are the risks of lumpectomy?
All surgery involves risk. Your surgeon will discuss the risks of your lumpectomy related to your specific medical history. In general, there can be some scarring or change in the shape of the breast, depending on the size of the area being removed. Other risks and complications associated with breast surgery include: wound infection, swelling around the incision from an accumulation of blood or clear fluid (uncommon) that may require drainage, and reactions to anesthesia (low risk).

Do I need to stay in the hospital after surgery?
Most of our patients do not need to stay overnight in the hospital unless they require a complete axillary dissection, have nausea and vomiting, or have pain which requires more active pain control.

How will I look and feel after surgery?
Post-surgery breast size depends on how much tissue was removed. There will be a scar from the incision. Initially there will be some swelling and discomfort. You will be given a prescription for pain medication to take at home if needed. If a complete axillary dissection was done, you will have a drain. Instructions for how to care for the drain will be given to you before you leave the hospital.

Post Operative instructions include:
Bring a bra with you to wear when you go home. Most women prefer a soft cotton bra, or stretch or athletic bra. Some women also find it comfortable to wear the bra at night when sleeping to give added support.
You will have a dressing on the area of the incision. Please leave this clean and dry until we see you in the office usually 7-10 days after your surgery.
You will be given a prescription for pain medication prior to being discharged from the hospital. Take the medication as needed for pain as prescribed by your surgeon.
Resume your normal activities as tolerated.
During the first week or so at home, you can expect to have tenderness in the incision and mild swelling of the area. You may also notice that under the incision the breast tissue is firm or hard. This is normal and will usually subside within several months.
Please call our office at 847-797-9000 if you have a fever greater then 101.0, increasing redness along the incision, or drainage from the incision area.

When do I learn the results of the lumpectomy?
It takes approximately 3-4 working days to get the pathology results. Your surgeon will call you with the results.

Will I need radiation therapy after a lumpectomy?
Standard care after a lumpectomy for most women includes 5-6 weeks of radiation therapy treatment in order to eliminate any cancer cells that may remain after surgery. There are some newer procedures for radiation treatment called IMRT and Mammosite that require less time for radiation. These new procedures require a specific profile for use, such as size of tumor, lymph node status, and age. You can discuss with your surgeon whether you are a candidate for these newer procedures.

If you have further questions, please call us at 847-797-9000.

 
 
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