Surgery is almost always needed to treat breast cancer. That means either lumpectomy or mastectomy to remove the tumor, depending on its type and stage.
If you've been diagnosed with breast cancer and your doctor is recommending a lumpectomy, you likely have questions. Dr. Michelle O'Shea, a breast surgical oncologist at Houston Methodist, is here to answer the most common ones.
What is a lumpectomy?
Lumpectomy is the term we hear most often, but Dr. O'Shea makes an important clarification: "Clinically, we refer to a lumpectomy for breast cancer as a partial mastectomy."
That's because a lumpectomy is the removal of any sort of breast lump — even a noncancerous one, like a benign lump causing uncomfortable symptoms.
"A partial mastectomy, on the other hand, is a cancer operation where we remove the cancerous lump from the breast, as well as a rim of normal tissue around it, and then put the breast back together again," explains Dr. O'Shea. "In a procedure like this, we're not just removing a lump. We're also focused on performing steps that help prevent breast cancer recurrence."
Removing surrounding healthy tissue is an example of such a step, as is depositing markers in the area to help guide radiation therapy — which is almost always needed after partial mastectomy. Both help ensure that any lingering cancer cells are destroyed.
With the full definition of partial mastectomy in mind, we'll simplify from here on out and just use the breast cancer definition of "lumpectomy," also sometimes called breast-conserving surgery.
Lumpectomy vs. mastectomy: What's the difference?
There are two main types of breast cancer surgery: lumpectomy and mastectomy. Now that we've defined lumpectomy, let's explore how it's different from a mastectomy.
"During a mastectomy, we remove the entire breast rather than a portion of it," explains Dr. O'Shea. "We can then follow this with breast reconstruction, either immediately or after further treatment."
In some cases, the breast skin, nipple and areola can be left intact during a mastectomy, often referred to as a nipple-sparing mastectomy.
"The goal of a lumpectomy for breast cancer is to remove the cancer while keeping much of the normal breast tissue in place so we can achieve good cosmetic outcome," adds Dr. O'Shea. "Whenever possible, we also perform what's called a hidden scar surgery, where we make the incision in a way that minimizes noticeable scarring."
One other important difference between these two breast cancer surgeries: A lumpectomy isn't always an option.
When is lumpectomy an option for treating breast cancer?
"The current standard of care for treating breast cancer is lumpectomy followed by radiation whenever possible and appropriate," says Dr. O'Shea.
When is this possible and appropriate? The answer is typically when the cancer is small and in its earliest stages. But not always.
"It really all comes down to the size of the lump relative to the size of the breast," says Dr. O'Shea.
If the lump is big and the breast is small, a lumpectomy won't leave an acceptable amount of breast tissue for follow-up imaging or appealing cosmetics. The shape of breast cancer matters, too. Lumpectomy isn't an option if the cancer doesn't form as a discrete lump.
"You can have stage 2 breast cancer that forms as a golf ball-sized lump but can still be removed via lumpectomy because the breast is large," Dr. O'Shea says. "But you can also have stage 0 breast cancer that forms like granulated sugar spread over the top a bowl of oatmeal, rather than as a compact lump. A mastectomy would likely be needed in that case."
Even aggressive types of breast cancer can sometimes be treated via lumpectomy. An example of this is when chemotherapy is needed before surgery. If this helps shrink the tumor enough, a lumpectomy might become an option.
Another time lumpectomy isn't an option is if you've had previous breast cancer treatment that included radiation, since an area of the breast can only be radiated once in a person's lifetime.
Does lumpectomy remove all cancer?
Most of the breast is retained during a lumpectomy, which may have you wondering whether it's as effective a treatment as a mastectomy. The latter is preferred by some women who feel more confident the cancer won't come back because the entire breast is removed.
"We now know that someone who has a lumpectomy followed by radiation therapy has the same risk of recurrence as someone who's had a mastectomy," says Dr. O'Shea. "Radiation reduces the risk of recurrence by at least 50% in all patients."
Breast cancer is a complex disease and recurrence does happen. That said, this risk is primarily influenced by factors such as the type of breast cancer, stage at diagnosis and lymph node involvement.
And for those worried about the side effects of the radiation therapy that follows a lumpectomy, Dr. O'Shea adds that the treatment doesn't make you feel sick or cause your hair to fall out. The most noticeable side effect is red skin, like a sunburn, and it typically resolves over time.
"For some women above the age of 70 who have favorable outcomes, we can omit radiation therapy and use medication and close monitoring to help reduce risk of recurrence," adds Dr. O'Shea. "We're also participating in a nationwide trial, called the 'DEBRA' trial, to assess whether the same can safely be done in women between the ages of 50 to 70 diagnosed with low-risk, early-stage breast cancer."
Is lumpectomy a major surgery?
Certain surgeries are extensive and require a hospital stay, but a lumpectomy almost never does.
"It's performed as an outpatient procedure in the majority of patients, so they go home the same day," says Dr. O'Shea. "Pain is fairly manageable afterward, and we usually apply a local anesthetic, so the area isn't as tender when the patient wakes up from surgery."
Over-the-counter pain medicine is enough to help most patients manage any pain afterward and normal activity can typically be resumed within one to two weeks of surgery.
"The goal is always to put the breast back together with a good cosmetic result, but if it looks smaller or lifted afterward, we can do a lift on the unaffected breast to match the new appearance," adds Dr. O'Shea. "When performed after cancer treatment, this type of lift surgery, for symmetry, is covered by insurance."
