A lumpectomy is the surgical removal of a small breast cancer lump. The primary goal in this surgical procedure is to preserve the breast. Only the tumor itself and adjacent tissue are removed.
What is lumpectomy?
A lumpectomy is the surgical removal of a small breast cancer lump. Lumpectomy is a breast-conserving surgical technique commonly used for breast carcinoma. Breast carcinoma is the malignant degeneration of the mammary gland. It is the most common form of cancer in women. The main feature of this surgical intervention is the extirpation of the breast tumor alone. In addition to the tumor, excision of the adjacent tissue is performed, taking into account a safety margin. Sometimes, the lymph nodes of the axilla must also be removed. Since the cosmetic result is considered more attractive than after a mastectomy, more and more women are opting for this breast-conserving surgery. Nowadays, more than 50% of all breast carcinomas are removed in a breast-conserving manner. Lumpectomy is also called wide excision. It belongs to the procedures of breast-conserving therapies, called BET for short. While the whole breast is removed in mastectomy, surgeons try to limit themselves to the tumor in the gentler method. This technique includes quadrantectomy. Here, a complete quadrant of the breast, including the overlying skin spindle, is extirpated. In old publications, the term tylectomy (Greek tylos = lump) is often used for lumpectomy.
Function, effect, and goals
For malignant breast carcinomas, lumpectomy is the most common technique of breast cancer surgery. With this surgical method, only a small part of the breast is taken out. This part consists of the tumor and the tumor area. Removing the adjacent area is important to eliminate the cancer cells around the carcinoma. Usually, surgeons first make a circular incision above the tumor. The final removal volume depends on the location of the tumor. If the diseased tissue is located directly under the skin, the skin spindle is usually removed. Now the surgeon can assess the size of the tumor. To do this, the surgeon palpates 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 more advanced technique of quadrantectomy, the breast is first divided into four quadrants. Removal of the laterocranial quadrant (upper lateral) is often done in conjunction with surgical removal of the lymph nodes in the armpit area. After each operation, an examination of the fine tissue takes place immediately. This is completed using a frozen section to ensure complete removal of the diseased tissue. If malignant cells are found again, re-excision must be performed. All patients must have 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 any 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 aftercare measures are required following the removal of a breast carcinoma. For example, a mammogram should be performed every six months for the first three years after the cancer tumor is diagnosed. If this period occurs without complications, this radiological procedure must be done annually in subsequent years. Another part of the follow-up examinations, apart from tumor control, is the observation of the patient with regard to possible side effects of medication. Attention must be paid to changes in the body and psyche as well as the development of intolerances. Lumpectomy is the preferred breast-conserving therapy for women under 75 years of age. For safety reasons, patients in the older age group still opt for complete breast removal. In addition, this is also the most common surgical approach for male breast carcinoma.
Risks, side effects, and hazards
The greatest risk associated with surgical removal of breast cancer occurs when the tumor has not been adequately removed.Remaining tumor cells prove to be extremely malignant. They lead to a significant reduction in five-year survival. In addition, concomitant radiation therapy is often more problematic in cancer recurrences than in initial sessions. The weakened immune system is more susceptible to the side effects of radiation treatment. As with all surgeries, lumpectomy carries a risk of infection. The wound cavity and the scar area are particularly affected by this risk. During the surgical procedure or postoperatively, the risk of thrombosis also increases. This blood clot occurs particularly in the lower extremities. The consequence of such a thrombosis can in turn be a pulmonary embolism. This results from the settling of a loose clot in a vessel of the lung. This type of embolism is often fatal. However, this sort of complication occurs extremely rarely. Another risk factor with this surgery is postoperative bleeding. The bleeding vessels around the operated site can cause postoperative bleeding. In a very small number of such rebleeding, the bleeding must be stopped surgically. With lumpectomy, as with most surgical procedures, certain risk groups are more susceptible to adverse sequelae than others. The high-risk group includes immunocompromised patients, women or men who have had previous site surgery, and older affected individuals. In addition, the stage of breast disease plays a significant role. The earlier the carcinoma is detected and removed, the fewer complications occur.
