Lumpectomy

Given all the confusion about the terminology, it’s comforting to know that the pro-
cedure for the lumpectomy itself is not nearly so confusing. In short, a lumpectomy is
the removal of a mass of tissue that has been identified as suspicious either by mam-
mogram, ultrasound, needle biopsy, or any or all of the above. The surgeon also re-
moves what he—and you—hope is a rim of benign tissue all the way around the
lump. In some cases, a lumpectomy may also be accompanied by another incision to
remove underarm, or axillary, lymph nodes, a surgery technically called a lymphec-
tomy. Typically, a lumpectomy is followed by radiation therapy, but that treatment
is entirely dependent on the pathologist’s report. More on that later.
Regardless of what it’s called, a lumpectomy is fairly routine—not to you, certainly,
but to your medical team. We’re here to tell you what it’s like.
Minus One Golf Ball
Let’s start with why your surgeon would recommend and why you would choose a
lumpectomy over a mastectomy. The primary advantage of a lumpectomy over a
mastectomy is fairly obvious: You still have two breasts when they’re done. It’s con-
sidered a breast-conserving measure, and for certain cancers, a lumpectomy com-
bined with radiation has been proven to be as effective as a mastectomy. But there
are some less obvious advantages, too. First, you’ll recover much more quickly and
easily after a lumpectomy (unless they took out lots of lymph nodes). Second, you’ll
retain most of the feeling in your breast and for some women at least, that sensation
directly affects their sex lives. Third, there’s minimal scarring.
But are there some situations in which a lumpectomy isn’t an option? Yep. Aside
from the fact that some malignancies are too far advanced for a lumpectomy (see
Chapter 5, “Decisions, Decisions, Decisions”), there are times when an otherwise
obvious choice of lumpectomy is the wrong choice:
1. You can’t have radiation a second time in the same spot. So if you’ve already
had radiation therapy on the affected breast, the typical lumpectomy–radiation
combo won’t work for you this time.
2. Maybe you have two or more suspicious areas
in the same breast. If they’re too far apart to
be removed through one incision, a lumpec-
tomy won’t work.
tomy won’t work.
3. If you’ve already had a lumpectomy but the
margins weren’t clear (i.e., cancerous tissue
showed up in the rim around the lesion), your
surgeon may try a second lumpectomy to get
clear margins. After that, a mastectomy is your
only choice.
4. If you have certain connective tissue diseases
that make you particularly sensitive to radia-
tion therapy, a lumpectomy won’t work for
you. Your doctor/surgeon will know and will
pass the word along to you.
5. If you’re pregnant and would require radiation
before your baby is born, the lumpectomy–
radiation combo won’t work for you, either.
Radiation can be harmful to the fetus.
So, yes, sometimes a lumpectomy isn’t an option.
Talk it over with your doctor.

Partial Mastectomy

Your surgeon may recommend a “partial mastec-
tomy.” The words sound scarier and more dramati
than “lumpectomy,” as if somehow they’re going
to remove lots of tissue. In reality, “partial mastec-
tomy” is often synonymous with “lumpectomy”
and the term doesn’t necessarily suggest how
much tissue your surgeon plans to remove. In
addition, a partial mastectomy may or may not
involve the removal of lymph nodes, but your
surgeon will tell you in advance what he plans
to do. Otherwise, ask.
It’s also possible your surgeon will recommend a
segmental mastectomy or quadrantectomy. The terms
may lead you to think you’re in for the removal of
at least a quarter of your breast, and you may be.
However, some medical teams use the terms rather
loosely—so again, ask if you’re unsure.
Bottom line: these words—excisional biopsy, inci-
sional biopsy, partial mastectomy, segmental mas-
tectomy, quadrantectomy, and lumpectomy—can
be synonymous.