Lumpectomy (lum-PEK-tuh-me) is surgery to remove a tumor and a small rim of healthy breast tissue while preserving the remainder of the breast tissue. It allows you to keep most of your breast. In contrast, a mastectomy removes the whole breast.

Lumpectomy is often the first treatment for early-stage invasive breast cancer or ductal carcinoma in situ (DCIS), a noninvasive form of breast cancer contained within the milk ducts.

Lumpectomy also is called breast-conserving surgery, wide local excision, partial mastectomy or segmental mastectomy. If a larger amount of tissue is removed, the surgery may be called quadrantectomy. An older term you may hear for lumpectomy is tylectomy.

Lumpectomy is usually followed by radiation therapy to the breast. This treatment helps lower the risk that cancer will return in the same breast.

Lumpectomy may be done using a standard approach or an oncoplastic approach. The decision depends on factors such as the size and location of the cancer, the amount of tissue that needs to be removed, breast size, and your preferences.

Standard lumpectomy

During a standard lumpectomy, the surgeon removes the cancer and some healthy tissue around it. The surgeon preserves as much of the natural size and shape of the breast as possible. After removing the cancer, the surgeon reshapes the remaining breast tissue to help reduce dents or other changes in breast appearance.

Oncoplastic surgery

Oncoplastic techniques may be used after a lumpectomy when a large amount of tissue is removed compared with the size of the breast. These techniques combine cancer surgery with plastic surgery. After removing the cancer, the surgeon adjusts the breast tissue to fill the area where tissue was removed and help preserve breast shape.

The surgeon may use tissue within the breast or from another area of the body to replace some of the removed tissue. Sometimes, surgery may be done on the other breast to make the breasts more similar in shape or size.

Excisional biopsy and lumpectomy

An excisional biopsy removes an area of concern, often with some surrounding breast tissue, so it can be examined for a diagnosis. The surgery may resemble a lumpectomy. But an excisional biopsy is done to find out whether the tissue is cancerous. A lumpectomy is used when breast cancer already has been diagnosed.

Excisional biopsy also may be used to take out certain noncancerous breast growths. These may include noncancerous growths called fibroadenomas that are growing, causing symptoms or changing breast appearance. Many fibroadenomas do not need to be removed.

Before the procedure

If the area to be removed is hard to feel or cannot be felt, you may have a procedure called localization before surgery. Localization uses imaging to mark the area to help the surgeon find it during the lumpectomy.

A healthcare professional who specializes in imaging, called a radiologist, uses mammography, ultrasound or another imaging test to locate the area. The radiologist then places a small device in or near the area to mark its location. The device may be a thin wire, radioactive seed, magnetic seed, radar reflector or another type of localization device.

The surgeon uses this marker as a guide during the lumpectomy. The localization procedure may be done on the day of surgery or earlier, depending on the type of device used. If the lump can be easily felt or identified with ultrasound, you may not need localization.

Sentinel lymph node surgery

The sentinel lymph nodes are the first underarm nodes to receive drainage from the breast. They typically are where cancer spreads first.

During a lumpectomy, your surgeon may remove some of these sentinel nodes to check for cancer cells. This is a procedure called sentinel lymph node surgery or sentinel lymph node biopsy.

To help the surgeon find the sentinel lymph nodes, a radioactive tracer, contrast material or both are injected into the breast. This material travels with fluid through a network of vessels and lymph nodes called the lymphatic system. It collects in the first few lymph nodes that drain the breast, helping the surgeon find them.

The surgeon removes these nodes through a separate incision under the arm. Other lymph nodes that look or feel concerning also may be removed. Sometimes, the lumpectomy incision is used to take out the nodes.

If the sentinel lymph nodes do not contain cancer cells, more lymph nodes usually do not need to be removed.

If the sentinel lymph nodes contain cancer cells, you may need more surgery to remove underarm lymph nodes. This surgery is called axillary dissection. Some people have cancer cells in only one or two sentinel lymph nodes. If radiation therapy will follow the surgery, they may not need surgery to remove more lymph nodes.

During the procedure

A lumpectomy is usually done under general anesthesia. General anesthesia uses medicine to put you into a sleeplike state during the procedure. You aren't aware during the surgery, and the anesthesia prevents you from feeling pain. A team of healthcare professionals gives the general anesthetics. The team might include an anesthesiologist and a nurse anesthetist. The team watches you closely during the surgery.

Your care team also might put medicine that causes numbness into the breast. This medicine, called a local anesthetic, helps decrease pain in the breast.

The surgeon makes an incision in the breast. The surgeon removes the cancer and some surrounding tissue.

After taking out the cancer, the surgeon reshapes the remaining breast tissue. For oncoplastic reshaping, the surgeon may rearrange tissue within the breast or use tissue from another area to help restore breast shape.

The breast tissue removed during surgery goes to a lab for testing. In the lab, a doctor who specializes in analyzing cells and tissue, called a pathologist, examines the tissue. If later testing finds cancer cells at the edge of the removed tissue, you may need another surgery to remove more tissue.

The surgeon may place small metallic clips at the site where the cancer was removed. These clips can help guide radiation therapy by marking the area where the tumor was removed.

The surgeon closes the incisions with stitches that usually dissolve over time and do not require removal. Your surgeon also may place thin adhesive strips or use glue on the incision to keep it closed until it heals.

Lumpectomy typically takes 1 to 2 hours.

After the procedure

After the procedure, your healthcare team takes you to a recovery area. Your team watches you closely as you come out of your sleeplike state. Most people leave the hospital on the day of surgery. Your healthcare team decides whether it's safe for you to go home.

Managing pain

You may have some discomfort after surgery. Your healthcare team might recommend medicine you can buy without a prescription to help with the discomfort. Follow your healthcare team's instructions.

Sometimes, stronger pain medicine is needed. Tell your healthcare team if you have pain. Applying ice to the painful area also might help.

Some people feel burning or shooting pain in the breast after surgery. This may be nerve-related pain. Tell your healthcare team about pain that is severe, gets worse or lasts longer than expected.

Instructions for home

Your healthcare team gives you instructions for caring for yourself at home. The team might go over these instructions with you and the person who helps you get home after surgery. Instructions from your healthcare team might include:

• How to take care of the surgery area.
• What medicines to use for pain.
• When to start taking your usual medicines again.
• Limits on your activity as you recover.
• Symptoms or changes that may mean there is a complication.
• How to contact your healthcare team.
• A list of your next medical appointments.

Returning to activities

Most people can return to light activities within a few days. Within about two weeks, most people can return to their usual activities. Recovery may take longer depending on the amount of tissue removed and whether lymph node surgery or oncoplastic surgery was done at the same time.

Ask your healthcare team how much time you may need away from work. The timing may depend on how you feel, how much surgery you had, and whether your work involves lifting or strenuous activity.

Your healthcare team tells you when you can drive again. Do not drive while taking pain medicine that affects your alertness. You also need to be able to move your arm comfortably, control the vehicle and drive safely.

Ask when you can return to lifting, exercise and other strenuous activities. Also ask when it is safe to swim, soak in a bathtub or use a hot tub. When you can return to activities depends on how the incision is healing and the extent of your surgery.

Breast care

Your healthcare team may tell you to wear a supportive surgical bra during recovery. Ask the team how long to wear it.

You may have swelling, bruising or tenderness in the breast while it heals. A buildup of fluid near the surgery area, called a seroma, also can occur.

You will likely have a scar where the surgeon made the incision. The breast also may have a dent or another change in shape where tissue was removed. These changes may be more noticeable when a larger amount of tissue is removed.