A Lumpectomy, as the name implies, is the removal of a suspicious lump in the breast tissue, along with some of the normal tissue around it.
Lumpectomy is also described by other medical terms (which mean slightly different things but still refer to the removal of a lump) such as (wide local excision), '(wide excision) biopsy', 'partial mastectomy', 'quadrantectomy', 'segmental excision' and 'wedge resection'. A quadrantectomy, for example, is where approximately a quarter of the breast tissue in an individual breast is removed. Lumpectomy surgery is generally classified as a type of Breast Conserving Surgery.
Once the lump is removed, it is sent for testing by a pathologist to determine if it is a benign or malignant lump. If it is determined to be malignant, more surgery may be needed. In deciding, the pathologist will take into account whether the cells surrounding the tumour are cancerous or healthy. If they are healthy (termed a 'clear margin') then it is likely that further surgery is not needed. If there is a close, positive or involved margin then more surgery is usually required, this is referred to as re-excision.
At the same time that the lumpectomy surgery is performed, it may be necessary to remove some of the lymph nodes in the armpit for testing (this is referred to as 'Sentinel Lymph Node Biopsy' or 'Axillary Dissection'). Again, if cancer cells are discovered in these lymph nodes, more breast cancer surgery may be needed.
The wide local excision can be combined with an oncoplastic procedure to improve cancer clearance and cosmetic outcome.
This type of treatment for cancer was introduced in the 1970s and is usually used in conjunction with radiotherapy. Prior to this, mastectomy, the total removal of the affected breast, was the only option. Lumpectomy is not always an option, and is generally only possible where:
- there is only a single lump, not multiple lumps
- there has not been a prior lumpectomy with radiation therapy
- the tumour is completely within the breast tissue (i.e. not attached to the chest wall for example)
- the tumour is less than 5cm in diameter (although this may be reduced by other therapy such as chemotherapy)
- radiation treatment is not precluded by other conditions e.g. collagen vascular diseases
- the patient is not pregnant, as radiation therapy can harm the foetus
There are many factors that need to be taken into account in deciding whether to choose breast conservation therapy or mastectomy. Dr John Gault is able to advise patients of all of the options and factors to be taken into account at a consultation in his clinic on the Gold Coast.