Lumpectomy and oncoplastic breast surgery in Toledo

What a lumpectomy is

A lumpectomy, also called breast-conserving surgery or partial mastectomy, removes the tumor with a rim of normal tissue around it. That rim is called the margin. After surgery, a pathologist examines the edges of the tissue under a microscope to confirm the cancer was removed completely.

Lumpectomy is used for invasive breast cancer and for ductal carcinoma in situ (DCIS). The same operation is also used to remove some benign or high-risk lesions that need a closer look.

• 1
  The tumorRemoved completely.
• 2
  The marginA rim of normal tissue removed with it. A pathologist examines its edges under a microscope.
• 3
  The rest of the breastStays. Oncoplastic techniques rearrange the remaining tissue so the breast keeps a natural contour.

Who is a good candidate

Most people with early-stage breast cancer can choose lumpectomy. It tends to be a good fit when:

• The cancer is small compared with the size of the breast, so it can be removed with a good result
• There is one area of cancer, or the areas are close together
• You are able to have radiation, if it is recommended
• Keeping the breast matters to you

Mastectomy may be advised instead when there are several separate areas of cancer, when the cancer is large compared with the breast, when you have had radiation to the chest before, or when an inherited mutation such as BRCA1 or BRCA2 makes risk-reducing surgery worth considering. For some larger cancers, medicine given before surgery can shrink the tumor enough to make lumpectomy possible. Read about mastectomy.

Oncoplastic lumpectomy

Removing a larger area of tissue can leave a dent or change the shape of the breast. Oncoplastic surgery plans for this from the start. The incision is placed where it will be least visible, and the remaining tissue is rearranged during the same operation so the breast keeps a natural contour. Depending on where the cancer is and the size of the breast, this can mean moving nearby tissue into the space, or combining the lumpectomy with a breast reduction or lift.

Dr. Mabry trained in oncoplastic surgery with Dr. Melvin Silverstein at the University of Southern California. That training shaped how she has operated ever since: remove the cancer completely, and leave the patient looking and feeling whole.

Margins, and why they matter

A clear margin means no cancer cells reach the inked edge of the tissue that was removed. If cancer cells do reach the edge, a second, smaller operation, called a re-excision, may be needed to remove a little more tissue. This happens in a minority of cases. It does not mean the treatment has failed, and it can usually be done through the same incision.

Margins have been a focus of Dr. Mabry's research since her fellowship, including a study of how margin width affects the chance of DCIS coming back. See her publications.

Clear marginNo cancer cells reach the inked edge.

Cancer cells at the edgeA re-excision removes a little more tissue (dashed line).

1. MarkingIf the area cannot be felt, a breast radiologist marks it beforehand.
2. SurgeryMost lumpectomies are outpatient: home the same day.
3. PathologyDr. Mabry goes over the final report with you.
4. RadiationUsually follows, to lower the chance of return.
5. Follow-upUsually a yearly mammogram of both breasts.

The day of surgery

Most lumpectomies are outpatient surgery, which means you go home the same day. If the area cannot be felt, it is marked beforehand by a breast radiologist, usually with a small marker placed under imaging guidance, so it can be found precisely in the operating room.

For invasive cancer, a sentinel lymph node biopsy is often done during the same operation. It removes only the first few lymph nodes that drain the breast to check whether cancer has spread, which spares most patients a larger lymph node surgery.

Recovery

Recovery from lumpectomy is usually quick. Most people are back to light daily activity within a few days and to full activity within one to two weeks, though everyone is different. Soreness is usually managed with over-the-counter pain medicine, and a supportive bra helps. At your follow-up visit, Dr. Mabry goes over the final pathology report with you and explains what it means for the next steps.

After surgery

• Radiation usually follows lumpectomy to lower the chance of the cancer returning in the breast. For some people, such as certain older patients with small, hormone-sensitive cancers, it may be safely left out. That is a decision you make with your team.
• Medicines such as endocrine therapy, chemotherapy, or targeted therapy depend on the features of the cancer, and are planned with your medical oncologist.
• Follow-up imaging continues, usually with a yearly mammogram of both breasts.

At Mercy Health, these decisions are made together with medical oncologists, radiation oncologists, radiologists, and pathologists. How treatment is planned.

Questions to ask about lumpectomy

• Am I a candidate for lumpectomy? If not, why?
• Would oncoplastic techniques help in my case?
• Where will the incision be?
• Will I need radiation, and for how long?
• Will my lymph nodes be checked during the same operation?
• What happens if the margins are not clear?

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