(Breast Conservation Therapy, BCT, Quadrantectomy)

Procedure overview

A lumpectomy is a type of breast-conserving surgery that may be used as a part of a treatment plan for breast cancer. During a lumpectomy, the cancerous lump and a portion of the breast tissue around the cancerous lump are removed. However, the breast itself remains intact. The surgeon may also remove some of the lymph nodes under the arm to determine if the cancer has spread.

Lymph nodes are bean-shaped structures that drain fluid from the breast area, upper arms, the neck, and underarm regions. Often breast cancer spreads to these lymph nodes, thereby entering the lymphatic system and allowing the cancer to spread to other parts of the body.

Radiation therapy is often administered following a lumpectomy to destroy cancer cells that may not have been removed during the lumpectomy procedure. In some cases, chemotherapy and radiation are given following a lumpectomy.

Anatomy of the breast

Each breast has 15 to 20 sections, called lobes, that are arranged like the petals of a daisy. Each lobe has many smaller lobules, which end in dozens of tiny bulbs that can produce milk.

The lobes, lobules, and bulbs are all linked by thin tubes called ducts. These ducts lead to the nipple in the center of a dark area of skin called the areola. Fat fills the spaces between lobules and ducts.

There are no muscles in the breast, but muscles lie under each breast and cover the ribs.

Each breast also contains blood vessels and vessels that carry lymph. The lymph vessels lead to small bean-shaped organs called lymph nodes, clusters of which are found under the arm, above the collarbone, and in the chest, as well as in many other parts of the body.

Reasons for the procedure

Lumpectomy is a viable treatment option for some women with small, localized breast cancers. Studies have shown that women who undergo lumpectomy followed by radiation have similar overall survival rates as those who undergo mastectomy.

There may be other reasons for your physician to recommend a lumpectomy.

In some cases, a lumpectomy may not be recommended as the treatment of choice. Reasons for not undergoing lumpectomy may include, but are not limited to, the following:

  • Previous radiation therapy in the breast/chest area

  • Two or more cancerous areas present within the same breast

  • Tumor that is large relative to a smaller-sized breast

  • Connective tissue disease(s) that are sensitive to radiation therapy

  • Pregnancy at the time of radiation following surgery

  • Tumor size larger than two inches that does not decrease in size following chemotherapy

  • Residual tumor left over from previous lumpectomy

Risks of the procedure

As with any surgical procedure, complications may occur. Some possible complications of lumpectomy include, but are not limited to, the following:

  • Temporary swelling of the breast

  • Breast disfigurement (size and shape)

  • Hardness due to scar tissue that can form at the site of the incision

  • Wound infection or bleeding

  • Lymphedema - swelling of the arm due to lymph node removal. This is preceded by early symptoms, which include a feeling of tightness in the arm, pain, redness, and decreased flexibility of the arm, hand, and wrist.

Seroma (clear fluid trapped in a wound) is normally present after a lumpectomy. Troublesome seromas can be drained in a surgeon’s office and treated with compression or an injection that helps to harden the space in the breast if necessary.

There may be other risks depending upon your specific medical condition. Be sure to discuss any concerns with your physician prior to the procedure.

Before the procedure

  • Your physician will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.

  • You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.

  • In addition to a complete medical history, your physician may perform a complete physical examination to ensure you are in good health before undergoing the procedure. You may undergo blood tests or other diagnostic tests.

  • You will be asked to fast for eight hours before the procedure, generally after midnight.

  • If you are pregnant or suspect that you may be pregnant, you should notify your physician.

  • Notify your physician if you are sensitive to or are allergic to any medications, iodine, latex, tape, or anesthetic agents (local and general).

  • Notify your physician of all medications (prescription and over-the-counter) and herbal supplements that you are taking.

  • Notify your physician if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.

  • You may be given a sedative prior to the procedure to help you relax.

  • Based upon your medical condition, your physician may request other specific preparation.