One of the treatments for breast cancer, lumpectomy is surgery to remove the part of the breast where the tumor is located. Unlike mastectomy, it is a conservative surgery. It is systematically followed by radiotherapy.

Lumpectomy is one of the surgical treatments for breast cancer. It involves removing the part of the breast where the tumor was diagnosed, as well as a small part of the tissues that surround it as a safety margin.

Unlike mastectomy which consists of removing the entire breast, lumpectomy is therefore a conservative surgery.

Before the intervention

When the tumor is large, the operation is sometimes preceded by chemotherapy or hormone therapy aimed at reducing the tumor and thus facilitating the operation. This is called chemotherapy or neoadjuvant hormotherapy.

Before surgery, breast identification is performed. This preoperative step allows the surgeon, on D-day, to easily find the tumor and thus remove as little breast tissue as possible. This identification is carried out by a radiologist, under local anesthesia, the day before the operation. Under ultrasound or mammographic control, the radiologist introduces a fine needle to the tumor. This needle is used to set up the marker, a flexible metal wire called a harpoon or hook. The outer part of the wire comes out and is fixed to the skin with a bandage. After the location, two mammograms, one from the front and the other from the side, are taken to check the positioning of the landmark. These images are sent to the surgeon for lumpectomy.

The day of the operation

Lumpectomy takes place under general anesthesia, in conventional hospitalization or in outpatient surgery.

After making an incision over or near the tumor, the surgeon removes the tumor with a small amount of healthy tissue around it. This is called the safety margin. The nipple and areola are preserved, unless the tumor is located behind them.

Breast reshaping is performed to avoid unsightly breast deformation.

The operative part is systematically sent for anatomopathology examination to ensure the absence of cancer cells at the level of the safety margin. If there was no prior biopsy or if this biopsy did not allow a sufficiently precise diagnosis to be made, the analysis of the tumor can take place during the operation itself to be able to adapt the operation if necessary. . This is called an extemporaneous examination.

Several metal clips, called radiopaque clips, are usually left in place at the tumor site. They will make it possible to easily find the area to be treated during radiotherapy, thanks to a simple X-ray.

A drain (small plastic or rubber pipe) is sometimes left in place at the incision in order to evacuate fluids (blood, lymph) that may accumulate during healing.

In the event of invasive cancer, the operation may be completed by excision of the sentinel node (s) (the first lymph nodes in the armpit closest to the tumor) in order to control, by pathological examination, the presence of cancer cells. This may require a second incision in the armpit.

Only certain types of breast cancer can be treated with lumpectomy. This is the case with breast carcinoma in situ. In this type of breast cancer, cancer cells are located only in the ducts of the breast (DCIS for ductal carcinoma in situ), or the breast lobules (CLIS for lobular carcinoma in situ).

The tumor should also be small enough for the size of the breast that it can be completely removed with a margin of healthy tissue around it.

Operative suites

Pain in the operated area is relieved by analgesic treatment based on morphine or derivatives. Wearing compression stockings and anticoagulant treatment are sometimes prescribed to prevent phlebitis.

Edema of the operated area, shoulder, chest or arm is common after lumpectomy. Most often it resolves spontaneously within a few days.

The hospitalization lasts from 1 to 4 days depending on the course of the intervention and the way in which the patient recovers.

The risks

Lumpectomy presents different risks:

• breast deformation: to avoid it, breast remodeling is always performed during lumpectomy;
• lymphocele, which is the formation of a lymph pocket under the scar. If necessary, an evacuating puncture will be performed;
• a hematoma, which may sometimes require surgical revision;
• an abscess;
• skin necrosis;
• phlebitis or embolism;
• phlebitis and embolism.

Complementary treatments

Lumpectomy is always supplemented by radiotherapy of the breast. In the presence of risk factors for recurrence, an additional dose called “boost” or “superimposition” can be performed on the tumor bed. Radiation therapy to lymph node areas may also be performed in certain situations.

Other treatments are sometimes associated with lumpectomy:

• chemotherapy possibly combined with targeted therapy if the tumor is HER2 positive;
• hormone therapy if the cancer is hormone dependent.

These complementary treatments to surgery are called adjuvants.

If the analyzes carried out on the safety margin reveal that it contains cancer cells, a second operation is necessary in order to be on the healthy margin (the band of tissue around the tumor must be free of cancer cells).