Lumpectomy

A Lumpectomy is the surgical removal of a small breast cancer lump. The primary goal of this surgical procedure is to preserve the breast. Only the tumor itself and the surrounding tissue are removed.

What is the lumpectomy?

Lumpectomy is a breast-conserving surgical technique that is often used for breast cancer. Breast cancer is the malignant degeneration of the mammary gland. It is the most common form of cancer in women.

The essential feature of this surgical intervention is the sole extirpation of the breast tumor. In addition to the tumor, the adjacent tissue is excised, taking into account a safety margin. Sometimes the armpit lymph nodes also need to be removed. Since the cosmetic result is perceived as more attractive than after a mastectomy, more and more women are opting for this breast-conserving operation.

In the meantime, more than 50% of all breast cancers are eliminated without preserving the breast. The lumpectomy is also called a wide excision. It belongs to the procedures of breast-conserving therapies, called BET for short. While the whole breast is removed in a mastectomy, surgeons try to limit themselves to the tumor with the gentler method. This technique also includes the quadrantectomy.

Here a complete quadrant of the breast, including the overlying skin spindle, is extirpated. In old publications the term lumpectomy is often used Tylectomy (Greek tylos = lump) used.

Function, effect & goals

Lumpectomy is the most common breast cancer surgery technique for malignant breast cancer. With this surgical method, only a small part of the breast is removed. This part consists of the tumor and the tumor area. Removing the adjacent area is important to eliminate the cancer cells around the carcinoma.

As a rule, the surgeons first make a circular skin incision above the tumor. The final collection volume depends on the location of the tumor. If the diseased tissue is directly under the skin, the skin spindle is usually removed. The surgeon can now assess the size of the tumor. To do this, the surgeon touches the tumor with two fingers and cuts it out with scissors. The margin of healthy tissue around the tumor that needs to be removed is between ten and twenty millimeters.

In the advanced technique of quadrantectomy, the breast is first divided into four quadrants. The removal of the laterocranial quadrant (top side) is often done in conjunction with surgical removal of the lymph nodes in the armpit area. An examination of the fine tissue takes place immediately after each operation. This is done with the help of a quick cut to ensure the complete removal of the diseased tissue. If malignant cells are found again, they must be re-excised.

All patients must receive supportive therapy after the procedure. Usually 5-7 sessions of radiation therapy are scheduled to be sure that all cancer cells have been destroyed. In addition to this type of therapy, antibody therapies are also used to kill remaining tumor cells. In the case of hormone-dependent tumors, anti-hormonal tumor therapy is also ordered. According to the guidelines of the German Cancer Society, additional follow-up measures are required after the removal of a breast cancer.

In the first three years after the cancer tumor is diagnosed, a mammogram should be performed every six months. If this period is uncomplicated, this radiological procedure must be carried out annually in the following years. In addition to tumor control, another component of the follow-up examinations is the observation of the patient with regard to possible drug side effects. Attention must be paid to changes in the body and in the psyche as well as the development of intolerances.

Lumpectomy is the preferred breast-conserving therapy for women under the age of 75. For safety reasons, patients in the older age group still opt for complete breast removal. It is also the most common surgical method for male breast cancer.

Risks, side effects & dangers

The greatest risk in the surgical removal of breast cancer arises when the tumor has not been adequately removed. Remaining tumor cells turn out to be extremely malignant. They lead to a significant reduction in five-year survival. In addition, the accompanying radiation therapy for cancer relapses is often more problematic than during the first sessions.

The weakened immune system is more susceptible to the side effects of radiation treatment. As with all operations, there is a risk of infection with lumpectomy. The wound cavity and the scar area are particularly affected by this risk. The risk of thrombosis also increases during surgery or postoperatively. This blood clot is particularly common in the lower extremities. Such a thrombosis can in turn result in pulmonary embolism. This occurs when a loose clot settles in a vessel in the lungs.

This type of embolism is often fatal. However, this type of complication is extremely rare. Secondary bleeding is another risk factor during this operation. The bleeding vessels around the operated site can lead to secondary bleeding. If the number of such secondary bleeding is very low, the bleeding must be stopped surgically. With lumpectomy, as with most surgical interventions, certain risk groups are more prone to negative side effects than others.

The risk group includes immunocompromised patients, women or men who have already had an operation on the site and older people. The stage of the breast disease also plays an important role. The sooner the cancer is detected and removed, the fewer complications there will be.