Breast-conserving Surgery (Lumpectomy)
Breast-conserving surgery is an operation to remove the cancer while leaving as much of the breast intact as possible. Some surrounding healthy tissue and lymph nodes are usually also removed. It’s often an option for a woman with early-stage cancer, and allows her to keep most of her breast.
- Breast-conserving surgery (BCS) allows a woman to keep most of her breast, but makes it likely she will also need radiation.
- Not all women with breast cancer are candidates for BCS. Talk to your doctor to find out whether BCS is an option for you.
- Studies show that choosing BCS (plus radiation) over mastectomy does not affect a woman’s chances of long-term survival.
- If you think you may want breast reconstruction, talk to your doctor before your breast cancer surgery.
- After BCS, most women will have radiation therapy. Some women might get other treatments as well, such as hormone therapy or chemotherapy.
- Side effects of BCS may include pain and lymphedema, a type of swelling, in the arm.
Breast-conserving surgery is sometimes called lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy. In this surgery, only the part of the breast containing the cancer is removed. The goal is to remove the cancer as well as some surrounding normal tissue. How much of the breast is removed depends on the size and location of the tumor and other factors.
Who can get breast-conserving surgery?
Breast-conserving surgery (BCS) is a good option for many women with early-stage cancers. The main advantage is that a woman keeps most of her breast. However, she will in most cases also need radiation therapy. Women who have their entire breast removed (mastectomy) for early stage cancers are less likely to need radiation, but they may be referred to a doctor who specializes in radiation, called a radiation oncologist, for evaluation because each patient’s cancer is unique.
Most women and their doctors prefer BCS and radiation therapy when it's a reasonable option. BCS might be a good option if you:
- Are very concerned about losing your breast
- Are willing to have radiation therapy and able to get to the appointments
- Have not already had the breast treated with radiation therapy or BCS
- Have only one area of cancer on the breast, or multiple areas that are close enough together to be removed without changing the look of the breast too much
- Have a small tumor (5 cm [2 inches] or smaller), which is also small relative to your breast size
- Are not pregnant or, if pregnant, will not need radiation therapy immediately (to avoid risking harm to the fetus)
- Do not have a genetic factor such as a BRCA mutation, which might increase your chance of a second cancer
- Do not have certain serious connective tissue diseases such as scleroderma or lupus, which may make you especially sensitive to the side effects of radiation therapy
- Do not have inflammatory breast cancer
Some women might be worried that having a less extensive surgery might raise their risk of the cancer coming back. But the fact is that in most cases, mastectomy does not give you any better chance of long-term survival or a better outcome from treatment. Studies following thousands of women for more than 20 years show that when BCS can be done, having mastectomy instead does not provide any better chance of survival.
Will I need breast reconstruction surgery after breast-conserving surgery?
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 (and possibly a plastic surgeon) before surgery to get an idea of how your breasts are likely to look afterward, and to learn what your options might be.
Recovering from breast-conserving surgery: What to expect after surgery
This type of surgery is usually done in an outpatient surgery center, and an overnight stay in the hospital is usually not needed. Most women can return to their regular activities within 2 weeks.
Ask a member of your health care team how to care for your surgery site and arm. Usually, you and your caregivers will get written instructions about care after surgery. These instructions should cover:
- How to care for the surgery site and dressing
- How to care for your drain, if you have one (This is a plastic or rubber tube coming out of the surgery site that removes the fluid that collects during healing.)
- How to recognize signs of infection
- Bathing and showering after surgery
- When to call the doctor or nurse
- When to start using the arm again and how to do arm exercises to prevent stiffness
- When you can start wearing a bra again
- What to eat and not to eat
- Use of medicines, including pain medicines and possibly antibiotics
- Any restrictions on activity
- What to expect regarding sensations or numbness in the breast and arm
- What to expect regarding feelings about body image
- When to see your doctor for a follow-up appointment
- Referral to a Reach To Recovery volunteer. Through our Reach To Recovery program, a specially trained volunteer who has had breast cancer can provide information, comfort, and support.
How can the doctors be sure all of the cancer was removed?
During the surgery, the surgeon will try to remove all of the cancer, plus some surrounding normal tissue.
After surgery is complete, a doctor called a pathologist will use a microscope to look at the tissue that was removed. If the pathologist finds no cancer cells at any of the edges of the removed tissue, it is said to have negative or clear margins. But if cancer cells are found at the edges of the tissue, it is said to have positive margins.
The presence of positive margins means that some cancer cells may have been left behind after surgery, so the surgeon may need to go back and remove more tissue. This operation is called a re-excision. If the surgeon can't remove enough breast tissue to get clear surgical margins, a mastectomy may be needed.
The distance from the tumor to the margin is also important. Even if the margins are “clear,” they could be “close”—meaning the distance between the edge of the tumor and edge of the tissue removed is too small and more surgery may be needed. Surgeons sometimes disagree on what is an adequate (or good) margin.
Will more treatment be needed after breast-conserving surgery?
Most women will need radiation therapy to the breast after breast-conserving surgery. Sometimes, to make it easier to aim the radiation, small metallic clips (which will show up on x-rays) may be placed inside the breast during surgery to mark the area.
Many women receive hormone therapy after surgery to help lower the risk of the cancer coming back. Some women might also need chemotherapy after surgery. If so, radiation therapy is usually delayed until the chemotherapy is completed.
Side effects of breast-conserving surgery
Side effects of breast-conserving surgery can include:
- Pain or tenderness
- Temporary swelling
- Hard scar tissue that forms in the surgical site
- Change in the shape of the breast
- Nerve (neuropathic) pain in the chest wall, armpit, and/or arm that doesn’t go away over time (called post-mastectomy pain syndrome or PMPS)
As with all operations, bleeding and infection at the surgery site are also possible. If axillary lymph nodes are also removed, other side effects such as lymphedema may occur.
Morrow M, Burstein HJ, Harris JR. Chapter 79: Malignant Tumors of the Breast. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 10th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2015.
National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Breast Cancer. Version 2.2016. Accessed at www.nccn.org on June 1, 2016.
Wolff AC, Domchek SM, Davidson NE, Sacchini V, McCormick B. Chapter 91: Cancer of the Breast. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 5th ed. Philadelphia, Pa: Elsevier; 2014.
Last Medical Review: June 1, 2016 Last Revised: August 18, 2016