Lumpectomy





Definition

Lumpectomy is a type of surgery for breast cancer. It is considered "breast-conserving" surgery because only the malignant tumor and a surrounding margin of normal breast tissue are removed. Lymph nodes in the armpit (axilla) may also be removed. This procedure is also called lymph node dissection.


Purpose


Lumpectomy is a surgical treatment for newly diagnosed breast cancer. It is estimated that at least 50% of women with breast cancer are good candidates for this procedure. The location, size, and type of tumor are of primary importance when considering breast cancer surgery options. The size of the breast is another factor the surgeon considers when recommending surgery. The patient's psychological outlook, as well as her lifestyle and preferences, should also be taken into account when treatment decisions are being made.

The extent and severity of a cancer is evaluated, or "staged," according to a fairly complex system. Staging considers the size of the tumor and whether the cancer has spread (metastasized) to adjacent tissues, such as the chest wall, the lymph nodes, and/or to distant parts of the body. Women with early stage breast cancers are usually better candidates for lumpectomy. In most cases, a course of radiation therapy after surgery is part of the treatment. Chemotherapy or hormone treatment may also be prescribed.

In some instances, women with later stage breast cancer may be able to have lumpectomies. Chemotherapy may be administered before surgery to decrease tumor size and the chance of metastasis in selected cases.


Contraindications to lumpectomy

There are a number of factors that may prevent or prohibit a breast cancer patient from having a lumpectomy. The tumor itself may be too large or located in an area where it would be difficult to remove with good cosmetic results. Sometimes several areas of cancer are found in one breast, so the tumor cannot be removed as a single lump. A cancer that has already attached itself to nearby structures, such as the skin or the chest wall, needs more extensive surgery.

Certain medical or physical circumstances may also eliminate lumpectomy as a treatment option. Sometimes lumpectomy may be attempted, but the surgeon is unable to remove the tumor with a sufficient amount of surrounding normal tissue. This may be termed "persistently positive margins," or "lack of clear margins." Lumpectomy is suitable for women who have had previous lumpectomies and have a recurrence of breast cancer.

Because of the need for radiation therapy after lumpectomy, this surgery may be medically unacceptable. A breast cancer discovered during pregnancy is not amenable to lumpectomy because radiation therapy is part of the treatment. Radiation therapy cannot be administered to pregnant women because it may injure the fetus. If, however, delivery would be completed prior to the need for radiation, pregnant women may

During a lumpectomy, a small incision is made around the area of the lump (A). The skin is pulled back, and the tumor removed (B). The incision is closed (C). (Illustration by GGS Inc.)
During a lumpectomy, a small incision is made around the area of the lump (A). The skin is pulled back, and the tumor removed (B). The incision is closed (C). (
Illustration by GGS Inc.
)
undergo lumpectomy. A woman who has already had therapeutic radiation to the chest area for other reasons cannot undergo additional exposure for breast cancer therapy.

The need for radiation therapy may also be a barrier due to nonmedical concerns. Some women simply fear this type of treatment and choose more extensive surgery so that radiation will not be required. The commitment of time, usually five days a week for six weeks, may not be acceptable for others. This may be due to financial, personal, or job-related constraints. Finally, in geographically isolated areas, a course of radiation therapy may require lengthy travel and perhaps unacceptable amounts of time away from family and other responsibilities.

Demographics

The American Cancer Society estimated that in 2003, 211,300 new cases of breast cancer would be diagnosed in the United States and 39,800 women would die as a result of the disease. Approximately one in eight women will develop breast cancer at some point in her life. The risk of developing breast cancer increases with age: women aged 30 to 40 have a one in 252 chance of developing breast cancer; women aged 40 to 50 have a one in 68 chance; women aged 50 to 60 have a one in 35 chance; and women aged 60 to 70 have a one in 27 chance—and these statistics do not even account for genetic and environmental factors.

In the 1990s, the incidence of breast cancer was higher among white women (113.1 cases per 100,000 women) than African-American women (100.3 per 100,000). The death rate associated with breast cancer, however, was higher among African American women (29.6 per 100,000) than white women (22.2 per 100,000). Rates were lower among Hispanic women (14.2 per 100,000), American Indian women (12.0), and Asian women (11.2 per 100,000).


Description

Any amount of tissue, from 1–50% of the breast, may be removed and called a lumpectomy. Breast conservation surgery is a frequently used synonym for lumpectomy. Partial mastectomy, quadrantectomy , segmental excision, wide excision, and tylectomy are other, less commonly used names for this procedure.

The surgery is usually done while the patient is under general anesthetic. Local anesthetic with additional sedation may be used for some patients. The tumor and surrounding margin of tissue is removed and sent to a pathologist for examination. The surgical site is then closed.

If axillary lymph nodes were not removed before, a second incision is made in the armpit. The fat pad that contains lymph nodes is removed from this area and is also sent to the pathologist for analysis. This portion of the procedure is called an axillary lymph node dissection; it is critical for determining the stage of the cancer. Typically, 10 to 15 nodes are removed, but the number may vary. Surgical drains may be left in place in either location to prevent fluid accumulation. The surgery may last from one to three hours.


Diagnosis/Preparation

Routine preoperative preparations, such as having nothing to eat or drink the night before surgery, are typically ordered for a lumpectomy. Information about expected outcomes and potential complications is also part of preparation for lumpectomy, as it is for any surgical procedure. It is especially important that women know about sensations they might experience after the operation, so the they are not misinterpreted as signs of further cancer or poor healing.

If the tumor is not able to be felt (not palpable), a pre-operative localization procedure is needed. A fine wire, or other device, is placed at the tumor site, using x ray or ultrasound for guidance. This is usually done in the radiology department of a hospital. The woman is most often sitting up and awake, although some sedation may be administered.


Aftercare

The patient may stay in the hospital one or two days, or return home the same day. This generally depends on the extent of the surgery, the medical condition of the patient, and physician and patient preferences. A woman usually goes home with a small bandage. The inner part of the surgical site usually has dissolvable stitches. The skin may be sutured or stitched; or the skin edges may be held together with steristrips, which are special thin, clear pieces of tape.

After a lumpectomy, patients are usually cautioned against lifting anything which weighs over five pounds for several days. Other activities may be restricted (especially if the axillary lymph nodes were removed) according to individual needs. Pain is often enough to limit inappropriate motion. Women are often instructed to wear a well-fitting support bra both day and night for approximately one week after surgery.

Pain is usually well controlled with prescribed medication. If it is not, the patient should contact the surgeon, as severe pain may be a sign of a complication, which needs medical attention. A return visit to the surgeon is normally scheduled approximately ten days to two weeks after the operation.

Radiation therapy is usually started as soon as possible after lumpectomy. Other additional treatments, such as chemotherapy or hormone therapy, may also be prescribed. The timing of these is specific to each individual patient.


Risks

The risks are similar to those associated with any surgical procedure. Risks include bleeding, infection, breast asymmetry, anesthesia reaction, or unexpected scarring. A lumpectomy may also cause loss of sensation in the breast. The size and shape of the breast will be affected by the operation. Fluid can accumulate in the area where tissue was removed, requiring drainage.

If lymph node dissection is performed, there are several potential complications. A woman may experience decreased feeling in the back of her armpit. She may also experience other sensations, including numbness, tingling, or increased skin sensitivity. An inflammation of the arm vein, called phlebitis, can occur. There may be injury to the nerves controlling arm motion.

There is a risk of developing lymphedema (swelling of the arm) after axillary lymph node dissection. This swelling can range from mild to very severe. It can be treated with elastic bandages and specialized physical therapy, but it is a chronic condition, requiring continuing care. Lymphedema can arise at any time, even years after surgery.


Normal results

When lumpectomy is performed, it is anticipated that it will be the definitive surgical treatment for breast cancer. Other forms of therapy, especially radiation, are often prescribed as part of the total treatment plan. The expected outcome is no recurrence of the breast cancer.


Morbidity and mortality rates

Approximately 2–10% of patients develop lymphedema after axillary lymph node dissection. Five percent of women are unhappy with the cosmetic effects of the surgery. The rate of cancer recurrence after five years is about 5–10%, and 10–15% after 10 years.


Alternatives

A procedure in which the entire affected breast is removed, called a mastectomy, has been shown to be equally effective in treating breast cancer as lumpectomy, in terms of rates of recurrence and survival. Some women may choose to have a mastectomy because they strongly fear a recurrence of breast cancer, and may consider a lumpectomy too risky. Others may feel uncomfortable with a breast that has had a cancer, and would experience more peace of mind with the entire breast removed.

A new technique that may eliminate the need for removing many axillary lymph nodes is being tested. Sentinel lymph node mapping and biopsy is based on the idea that the condition of the first lymph node in the network, which drains the affected area, can predict whether the cancer may have spread to the rest of the nodes. It is thought that if this first, or sentinel, node is cancer-free, then there is no need to look further. Many patients with early-stage breast cancers may be spared the risks and complications of axillary lymph node dissection as the use of this approach continues to increase.


Resources

BOOKS

Love, Susan M., with Karen Lindsey. Dr. Susan Love's Breast Book, 3rd ed. Cambridge: Perseus Publishing, 2000.

Robinson, Rebecca Y. and Jeanne A. Petrek. A Step-by-Step Guide to Dealing With Your Breast Cancer. New York: Carol Publishing Group, 1999.


PERIODICALS

Apantaku, Leila. "Breast-Conserving Surgery for Breast Cancer." American Family Physician 66, no. 12 (December 15, 2002): 2271–8.

Dershaw, D. David. "Breast imaging and the conservative treatment of breast cancer." Radiologic Clinics of North America 40, no. 3 (May 2002): 501–16.


ORGANIZATION

American Cancer Society. 1599 Clifton Rd. NE, Atlanta, GA 30329-4251. (800) 227-2345. http://www.cancer.org .

National Cancer Institute (NCI) <http://cancertrials.nci.nih.gov/types/breast/treatment/sentnode& x003E; .

National Lymphedema Network. 2211 Post St., Suite 404, San Francisco, CA 94115-3427. (800) 541-3259 or (415) 921-1306. http://www.wenet.net/~lymphnet .


Ellen S. Weber, MSN
Stephanie Dionne Sherk

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?


Lumpectomy is usually performed by a general surgeon or surgical oncologist. Radiation therapy is administered by a radiation oncologist, and chemotherapy by a medical oncologist. The procedure is frequently done in a hospital setting (especially if lymph nodes are to be removed at the same time), but specialized out-patient facilities are sometimes preferred.

QUESTIONS TO ASK THE DOCTOR


  • Why is a lumpectomy recommended?
  • What method of anesthesia/pain relief will be used?
  • Will radiation or chemotherapy be administered?
  • Will a lymph node dissection be performed?
  • Am I a candidate for sentinel node biopsy?


User Contributions:

KATHLEENODONNELL
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Oct 30, 2007 @ 1:13 pm
I HAVE BEEN TOLD THAT I DO NOT HAVE BREAST CANCER BUT I STILL NEED A LUMPECTOMY. WHY. SOME ABNORMAL CELLS WERE INITIALLY FOUND BUT NEVER HEARD ANYTHING MORE. PLEASE HELP. IT IS TO BE DONE BY FINE WIRE METHOD.
Carol B.
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Jan 14, 2008 @ 1:13 pm
I had a lumpectomy last week for 2 lumps near each other. I still cannot believe how well I felt afterwards. I had no pain, and only a sensation of numbness when I touch the area. I have been able to do my usual activities, and even went out tolunch 2 hours after surgery. Don't be afraid of this surgery.
lamai gladys
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Feb 4, 2008 @ 8:08 am
i had my surgery a month ago for the second time and i just wanted to know more.i find this forum helpful and educative too. so thanks and keep the good work going.
Lisa
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Aug 12, 2009 @ 11:11 am
the smears show occasinal non specific inflammatory cells including foamy macrophages and lympocytes.Three is scantly coagulated proteinous material.There are only stray small ductal epithelial cells.
What does this mean?
GenThel
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Nov 17, 2009 @ 7:07 am
I HAVE BEEN TOLD THAT I DO NOT HAVE BREAST CANCER BUT I STILL NEED A LUMPECTOMY. WHY. SOME ABNORMAL CELLS WERE INITIALLY FOUND BUT NEVER HEARD ANYTHING MORE. PLEASE HELP. IT IS TO BE DONE BY FINE WIRE METHOD. Why if normal results after mamogram, ultrasound and even a niddle biopssy I still need a general surgeon to practice a lumpectomy? Please explain.
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Apr 6, 2010 @ 11:11 am
I was just diagnosed with Breast Cancer, I am scared, worried, and anxious. I am studying more about it I am ignorant to what it is all about.I am only 47 years of age. and also diagnosed with Diabetes five years ago. What do i do!
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May 1, 2010 @ 3:15 pm
i have just been for my first ever mamogram, and was re-called, and told i had a tumor on my left breast measuring 11mm, and i had an ultrasound scan and biopsy, but the doctor told me at the time he suspects it defiantely IS malignant, and the biopsy results are still not available.
im not sure how she can determine that certainty just by seeing it on an ultrasound screen, but i have to believe she knows what she is talking about and i have prepared myself for the worst news. i have 4 days before getting my results and terrified. i am 49. she told me that it is treatable and will need an operation (lumpectomy i think), sent me home and told me not to worry! (yeah right)that its ONLY 11mm. its 11mm i dont want inside my body thank you very much. one thing i would advise though, as much as you might not want to, tell your loved ones as soon as possible, cos you cant rely on there support if they dont know, and this waiting period is horrendous, and you DO need to talk.
lisa
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Jul 29, 2010 @ 6:06 am
I had to go back for a more diagnostic mammogram which revealed a tiny cluster of calcifications. I had the stereotactic biopsy which was unpleasant but not unbearable. Local anesthetic was used. I was diagnosed with atypia which is atypical ductal hyperplasia(abnormal cells which could be precancerous) and immediately set up with an appointment with a surgeon for a lumpectomy. I went in for my lumpectomy yesterday. I did not have any lymph nodes removed, only the cluster/lump. I really dont have much pain at all surprisingly enough. Only some tenderness at the incision. Maybe this will hit me later, I dunno:-) I go back in a week to my surgeon for my pathology report which hopefully will reveal clear margins on my tissue and no cancer cells. To anyone who is stressing over a biopsy and or lumpectomy..try not to get over stressed about the procedures. I did that and got myself all worked up about it and scared..and it really wasnt that bad. The worst part is really the waiting for results. Hope this helps:-)
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Oct 14, 2010 @ 9:21 pm
Had lumpectomy 6mos. ago, had 6 1/2 wks radiation. Then got infection in breast and in hospital for 7 days, having breast drained and antibiotics. Have been back twice to have it drained and last time Dr. said I could wait a couple of mos. to come back. Didn't want to keep sticking needle in, as there was a chance of infection each time he did. My arm and breast are still sore and uncomfortable. Went to radiation Dr. for checkup last month and he said I was doing good and not to keep draining, he thought it would take care of itself. I really don't know what to think. Trying not to let it worry me, but tired of being uncomfortable. Has anyone had this problem?
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Nov 28, 2010 @ 9:09 am
I have a 1.2 cm lump on top outer part of my breast. I can feel it real good. I was told that I am to have a lumpectomy and radiation after. I am choosing to have the lumpectomy with only a local and no sedation. I am also having the sentinel node biopsy done at the same time. I have been told that that is the worst and to make sure they numb me before doing the snb..has anyone had this all done with a local only and no sedation? Also, wondering why some of these women did not have the snb done. What makes the difference between a surgeon doing this and not doing it?
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Nov 29, 2010 @ 11:11 am
I had a lumpectomy one week ago Friday. I went back this morning for the pathology reports. I need to go back for a 2nd lumpectomy for closer margins. Has anyone had this done?
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Nov 30, 2010 @ 1:01 am
Thanks for your encouraging message Carol B.! I start my treatment tomorrow with sentinal node mapping, then a lumpectomy on Thursday. Even if I do half as well as you, I will be ecstatic!
Laura
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Jan 17, 2011 @ 8:20 pm
I had a lumpectomy and removal of sentinal node(s) 10 days ago. I had general anesthesia. Five days after the surgery I started mammosite radiation. The catheter for radiation was implanted in the cavity left by the tumor. I went for treatments twice a day for only 5 days. It was not too bad. I didn't have any fatigue until Sunday ( two days after radiation). Today (MOnday) I'm fine. My pathology report was all good and lymph nodes negative. Yay!
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Mar 6, 2011 @ 10:10 am
I was told thru a mammogram screening that there was dark shadow over the left outer quadrant of my left breast which suggest possible malignancy.. My Dr. advised lumpectomy, forzen section and sentinal node biposy to determine cancer...
Should I go for the lumpectomy as I risk killing a good piece of my breast tissues..

Pls help me understand better..
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Mar 25, 2011 @ 12:12 pm
I had a lumpectomy & sentinenol node 6 nodes removed for 8m cancer tumor in october since then I have had nothing but pain since, my arm is hurting me and hurts to the elbow, i had a terrible infection where the site under the arm burst open and I had to be on antibitiocs via iv at emergency as I could not get anyone to listen I was even radiated with the infection but no one would listen to me , now its March and my Doctor feels the infection is coming back again, and it hurts terribly. Has anyone had these issues please let me know need answers please
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Mar 27, 2011 @ 9:21 pm
I had a lumpectomy back on the 17th of january. I had horriable pain! Now after two months the incsion opens up and the pain is horriable. I have contacted my doctor she has me going back and seeing a surgeon. My question is has anyone else had this problem?
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May 19, 2011 @ 12:00 am
HI
I had my lumpectomy 7 days ago,all went well.But Saw the surgeon yesterday and she wandered how long I have had the infection,my breast is sooo sore,swollen and red,I said I didn't know ,thought it was all apart of it..??She has put me on keflex for 10 days.Went for my walk tonight,and had to come home after half a block to painful even to walk.I have been told by others to put ice on to relieve the pain??Anyone know??
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May 26, 2011 @ 10:22 pm
This is very informative, thank you for your effort.
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Jun 3, 2011 @ 12:00 am
I am now having the same problem, I have an infection where they did the surgery, was put on antibiotics by a regular doctor, but its not getting better, its getting worse, I feel weak, and now its swelling and parts of it are turning purple and it hurts really bad. I am only 37 but am scared to death right now. I finished chemo and was supposed to do radiation but havent started yet, im not sure what I should do, that same doctor wants me to come back but im debating just going to the emergency room! What would u suggest?
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Jun 19, 2011 @ 5:05 am
I had a lumpectomy SNB 1 1/2 weeks ago and everything went fine and margins are clear. I went to the post op check up and the surgeon drained some old blood and fluid. Since then the breast is still swollen and there is a new bruise about 2" X 2" that has developed above the incission all the original bruises have healed and it is painful not bad like a 4 on a 1-10 scale. Should I be concerned and what do you think could cause this. It is the weekend anI am going to call the Dr.
on Mon. unless things get worse.
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Jul 14, 2011 @ 6:06 am
I am currently a 41 yr. old female living in LA. In Aug. 2009 i was diagnosed with breast cancer in my rt. Breast (DCIS, triple negative & just below stage 2 as it was 1.8 cm.) and subsequently had TWO lumpectomies due to the first surgeon failing to excise up to the "margins" of the tumor AND FAILING to test ANY of my lymph nodes for any spreading of the cancer.
This made the job of the 2nd surgeon more difficult to determine which lymph nodes corresponded to the ducts (?) to test for nodes that were non-cancerous. The 2nd surgery was very, very beneficial as he had the pathology dept test the tissue results before I was finished with my lumpectomy. I recently (approximately a month ago) had a battery of tests performed on me (mammograms, ultrasound, bone scans, MRI's on my brain as my "chemobrain" is just NOWo starting to improve and my breasts as i have been experiencing excrutiating pain in rt. breast (sometimes both), a bone scan (? I had so many tests it's hard to keep track) and ultimately I had a Pet/ct scan that detected abnormal activity in lymph node #18. My BC surgeon is looking into a needle biopsy done thru my ribs/chest area to diagnose the "abnormal activity" as reflected in the PET/CT ONLY & my oncologist said my bloodwork was normal.
If the dr is unable to perform a needle biopsy due to it's location either I wait 2-3 months & have another PET at that time to see if the "abnormal activity" is still detectable in node #18 OR attempt a risky, painful thoracic surgery to remove ??? from behind my chest wall.
What is the best option for long-term survivability as 3 months seems a LONG time to wait especially if it could be spreading to other lymph nodes. I want to live a long, healthy, meaningful life as I'm only 41 & have a lot of living to do.
Thank you for your attention & sorry so long.
Melissa Callans
Los Angelesl
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Sep 21, 2011 @ 11:23 pm
Thank you for all the previous posts. They have been very informative. I had a lumpectomy 1 1/2 weeks ago. I was fortunate as my cancer was stage 1. The lumpectomy went well, and the pain subsided after the seond day. However, today, 9 days after surgery, my breast area and under my arm was fairly painful. Where the tape was for the bandage looked like a welt, and the skin started peeling off last night. I carefully washed the area and put polysporin on it this morning. I did not have a drainage tube placed. I go back to the doctor in four days to have the tape removed over the incisions, and then one week later go back for another surgery so we can have clearer margins. Once I have healed from the surgery, I will go through six weeks of radiation. I have had several heart surgeries for a congenital heart defect 7 yrs ago, and am concerned the radiation could cause heart problems. I am hopeful the rest goes well and I do not have any complications.
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Dec 16, 2011 @ 11:11 am
I am going to have a lumpectomy on Wednesday and I am worried because I had by pass surgery two years ago. I am very scared any thoughts.
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Dec 18, 2011 @ 11:11 am
Dear Louise, I had a lumpectomy on 12/2. They found 2 small tumors next to each other - 4 millimeters and 7 millimeters - and did not spread to sentinel lymph node (which was likewise removed). The margins are clean. Very early stage 1. The scariest part for me was when my annual mammo came back irregular (on 10/12) up until the time of the surgery (on 12/2). I was worried if it spread to lymph nodes and first thing I asked when waking up in recovery was that. Otherwise, recovery stage pretty easy. I had a reaction to the surgical tape and had to put cortizone on the two raw rashes. Otherwise, I did not have to take any painkillers when the anesthesia work off. I went to work a week later (my choice). I had my first follow-up this past Tuesday and the only thing is the breast has some redness and swelling so my doctor put me on antibiotic. I see her again in 2 weeks for followup and will start radiation sometime after New Year. Otherwise, I am doing things pretty normal BUT owing that I am working full-time making that my priority and as my pretty much major life activity except for personal things for myself. If ever there is a time to pamper yourself, it is now and as a bc patient, an entitlement. Just wanted to write that the procedure and after effects far easier than the wait. God Bless You. Be strong and good attitude and support network always helps.
rafeef
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Jan 12, 2012 @ 2:02 am
why post lymph node dissection the radiotherapy was contrindicated??
veronica
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Jan 20, 2012 @ 4:16 pm
I just had a lumpectomy/snb yesterday and feel great! I had sedation and felt grumpt when I came to but it wore off quickly. I used the painkillers to sleep. Hope the pathology report is positive.
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Jan 30, 2012 @ 4:04 am
Your site is very informative thank you.
However I had a lumpectomy 5 years ago, had lymph nodes removed they said as a precaution but there was no cancer in the nodes, I have lymphodema which is annoyingly painful I have been numb down my right side to my waist back and front and down to my elbow and my armpit since the operation, I have damaged breast tissue due to the radiotherapy and so far have had seven breast infections, I am now allergic to penicillin which is more than annoying so I have been suffering for five bloody years with pain to the point where I sometimes feel suicidal. My last two infections were October and the present time and quite frankly I have had enough and am now close to seeing my surgeon to tell him I want my breast removed immediately, no one has looked into why I keep getting infections in the breast and sometimes I have been told this pin is simply something I have to live with, no flaming wonder I have felt suicidal. pretty sick of all this. Hope no-one else suffers this way.
Barbara
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Feb 16, 2012 @ 6:18 pm
Could someone comment on a fluid build up in the cavity following a lumpectomy
Gill
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Mar 6, 2012 @ 8:08 am
I had DCIS with radiation treatment and now I've been diagnosed with DCIS again, in the same breast. I'm told I am not a candidate for radiation treatment due to my history. I'm really scared for the prognosis and I feel very isolated and depressed. Has anyone else been through anything similar?
sue matthews
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Mar 10, 2012 @ 2:02 am
Hi, to Barbara (No 28). I had a lumpetomy a week ago and within a few hours of coming back from theatre I developed a haemotoma in my breast and had to go back to theatre to have it drained. This only happens to 2% of lumpectomy patients! I was fine and once the fluid had been drained my breast very quickly started to heal. The surgeon was wonderful as were the nurses. The thing is we are in good hands with great support. It helps enormously with what we are all going thorough. I hope this helps.
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Apr 28, 2012 @ 10:10 am
I was just diagnosed six days ago. Early, small stage 1A bc near the chest wall. Found through routine mammo. I am devastated like everyone. Breast specialist says I am an excellent candidate for a lumpectomy followed by radiation. She had me visit a plastic surgeon yesterday for consult on reconstructive surgery, which she thought would take place immediately following her surgery. He told me he wouldn't be able to touch me for at LEAST six months after radiation due to the location of the cancer. He explained all the upper fullness of my breast would be shrunk up and how damaging radiation is to breast tissue and so difficult to work with a radiated breast. Said it make the tissue very hard inside and out. He saud twice that radiation is a plastic surgeons woest nightmare. He showed me photos of his work explaining he sees the worst of the worst. I cried like a baby looking at such uneven, awful looking breasts that he had worked on after mastectomies, lumpectomies and radiation. I didn't see a set of breasts where the two looked the same. The nipples were asymmetrical, as well as the breasts, with one being larger than the other or hanging lower, etc. He is considered an excellent surgeon and one third of his practice is reconstructive breast surgery after treatment for breast cancer. I guess I'm very vain, but not only am I scared of the cancer and recurrence, I am scared of being so disfigured after radiation. How about any of you?
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Apr 29, 2012 @ 7:07 am
I was just diagnosed six days ago. Early, small stage 1A bc near the chest wall. Found through routine mammo. I am devastated like everyone. Breast specialist says I am an excellent candidate for a lumpectomy followed by radiation. She had me visit a plastic surgeon yesterday for consult on reconstructive surgery, which she thought would take place immediately following her surgery. He told me he wouldn't be able to touch me for at LEAST six months after radiation due to the location of the cancer. He explained all the upper fullness of my breast would be shrunk up and how damaging radiation is to breast tissue and so difficult to work with a radiated breast. Said it make the tissue very hard inside and out. He saud twice that radiation is a plastic surgeons woest nightmare. He showed me photos of his work explaining he sees the worst of the worst. I cried like a baby looking at such uneven, awful looking breasts that he had worked on after mastectomies, lumpectomies and radiation. I didn't see a set of breasts where the two looked the same. The nipples were asymmetrical, as well as the breasts, with one being larger than the other or hanging lower, etc. He is considered an excellent surgeon and one third of his practice is reconstructive breast surgery after treatment for breast cancer. I guess I'm very vain, but not only am I scared of the cancer and recurrence, I am scared of being so disfigured after radiation. How about any of you?
Joellen
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May 9, 2012 @ 6:18 pm
I was just diagnosed today with early stage of breast cancer. My surgeon is talking lumpectomy and diagnosing lymph glands during the surgery. I did not realize that lumpectomys can be so disfiguring. What about breast implants instead of just reconstructive surgery so that each breast is more symmetrical or are breast implants part of the reconstructive surgery?
Sharon Leeds
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Aug 4, 2012 @ 4:16 pm
I have just had a lump removed and lymphs for breast cancer. I also had breast cancer 3 years ago in my other breast but then my lymphs tested positive and I had a full lymph clearance. This time my lymphs tested negative I am now waiting to start radiotherapy for three weeks last time it was for four weeks.
Lynn Frost
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Sep 19, 2012 @ 3:15 pm
I've been studying about radiation therapy because I had a lumpectomy and my doctor is recommending it. I noticed so many posts here regarding questions about surgery when there is believed to be no cancer involved. I thought I might share some of my history that might help some of you who have these questions because I know from experience how scary this can be! Ten years ago I was diagnosed with LCIS (lobular carcinoma in situ) considered to be not a cancer but a marker for cancer which puts one at a high risk. That was back in 2001. At that time I originally had a diagnosis of DCIS from a local lab. I then asked for a second opinion and received a different diagnosis of LCIS a week later. I was in college at the time taking final exams and I really didn't need all this. I decided to get a THIRD opinion to confirm which it was. When I went to the doctor to get my tissue samples so I could go out of state to USC (Norris Cancer Center) to have them test me, my doctor told me he had already taken the liberty of sending my samples to OSHU in Portland, OR for the third opinion. I was angry because I wanted to take the tissue samples with me and had to wait. When the results came back from OSHU, guess what? I got a still different diagnosis---DCIS with possible "invasion"!!! So now I had three different diagnoses within about two months time. I decided to fly to California with my tissue samples and see Dr. Melvin Silverstein (the surgeon who treated Suzanne Sommers with her breast cancer). At USC they did more tests on me and I spoke with Dr. Silverstein who told me he though the diagnosis of LCIS (not a cancer but high risk marker) was correct, but because of all the confusion surrounding my case, he suggested I consult with Dr. Michael D. Lagios of the Breast Cancer Consultation Service in Tiburon, CA. Dr. Lagios is a renown pathologist. In fact, he and Dr. David Page, Vanderbilt University, TN are the two top pathologists for what is considered the "low end" of breast cancer. If you want more info on this, please e-mail me at lynfrost@hotmail.com.

I sent my biopsy samples to Dr. Lagios back in 2001. He then studied them and agreed with Dr. Melvin Silverstein that my diagnosis should be LCIS, not DCIS or DCIS with invasion. However, since there was so much confusion surrounding my case, Dr. Lagios advised me to get an excisional biopsy in order to see more tissue and make certain the surrounding area was the same as the small amount of tissue he looked at in the needle biopsy samples. I did get the excisional biopsy done as a surgery. It was painless and healed very quickly without hardly a trace. Dr. Lagios verified the diagnosis of LCIS. I had no further treatment for ten years other than regular checkups every six months---once with my local OBGYN and another manual checkup from the surgeon who did my biopsy. This year I was diagnosed with invasive lobular cancer. It seems I was the one of 5-10% who got it with a diagnosis of LCIS. So in March I had a lumpectomy to my right breast and I'm now taking an aromatase inhibitor to block the estrogen and getting ready to receive radiation therapy. I refused chemo and later was tested with what is called an Oncotype DX test and discovered I did not need chemo even though my surgeon in Seattle, WA was pretty much threatening me to get it.

From my experience there is a great deal of over treatment and fear surrounding the big "C" word. I don't like to act in fear!!! I would prefer to glean all the knowledge I can and educate myself as well as pray and received my guidance from my Creator.
Vicki
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Sep 26, 2012 @ 12:00 am
I am haveing my done this Thursday , I am 27 this will be my first surgery ever. I am very scared and don't know what to expect after. Can anyone help to understand what I will be going through. My doctor is always in such a hurry I don't get to ask the things I want to ask him.
HELEN
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Oct 9, 2012 @ 6:06 am
I breat cancer about 20yrs ago. now i am having sever pain in the same breast, should i be worried
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Jan 16, 2013 @ 10:22 pm
Hello Family, I was diagnosed last week with early stage
of brast cancer. My surgery for a Lumpectomy is Friday the
18th of January, very scare. What I wanted to be able to
thank you for your support.
Twyla
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Mar 9, 2013 @ 9:21 pm
This is to Judy P in Houston: Hi Judy, on January 8, 2013 I had a lumpectomy on my right breast. I am 60 yrs old and in very good shape. I was shocked. The surgeon did a fantastic job. Good margins and seems to have gotten all of it. On March 20th I start 16 rounds of radiation. After the surgery I thought "O this isn't so bad, I am not that deformed." Well my right breast is now is about an AA size as opposed to my left which is quite a lovely C. I was told by my oncologist that the plastic surgery will not be done for at least 18 months because it takes that long for the breast to heal after radiation. Since I haven't had radiation yet, I am not sure I am going going to have reconstruction done, it still remains an option. You Judy, are not the only vain woman on the planet, I have had a face lift, a tummy tuck and am not apologetic about any of it. Having two very different breasts is very disturbing when I look at myself in the mirror. The only thing I can say to you is this "I have my life and am very grateful and thankful to God for that". You will get through this time. Even if you can't have reconstruction done for a while, you will come through this a much stronger woman. My prayer is this: Please Lord let there be a cure for this horrible disease so that we as women can fulfill our full potential. God Bless you Judy on your Journey.
Jody
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Jun 9, 2013 @ 9:21 pm
In response to #28, my incision also opened. I had a lumpectomy on my right breast as well as sentinel node removal. The surgeon removed the tumor and the margins were clean. The incision for the tumor removal actually leaked through all the dressings shortly after I returned to work on day 10. Two days later after I showered and prepared to get dressed to go to work in the morning , all drainage literally came pouring out and I was in a panic (unaware this could happen). My onco test put me in the moderate range but the pathology of my tumor showed it to be aggressive so chemo was recommended along with hormonal therapy and radiation. I am now at 8 1/2 weeks since surgery and still of have an open wound and am using wound vac therapy to help speed up the heeling since I was told that chemo needs to be done by week 12 at the latest. It looks like I will not be doing chemo since the wound will still be open. I still consider myself lucky that the surgeon is confident all the cancer was removed but very am anxiuos to get treatment and get all this behind me. I never thought I would be left with a gaping hole 2 inches at the deepest point by about 4 1/2 inches. I am following up tomorrow with the wound specialist who is coordinating with my oncologist. It has been an ordeal just trying different things to get my wound healed. I was reading some of the comments but didn't see any about what I experienced. there has to be other women who have had something similar.
Jen
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Feb 18, 2014 @ 4:16 pm
Has anyone had a lumpectomy by their gyn. I'm scheduled late March for a lumpectomy by a breast surgeon but just talked to my gyn who is willing to do the surgery next week. Should I trust my gyn to do the surgery or wait it out and have the specialist do the surgery? I'm anxious to be cancer free!
vera
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Feb 28, 2014 @ 3:15 pm
I had a lumpectomy on 2-ii. The surgeon told my husband that everything he took from me was clean. I see the surgeon on monday march 3rd, but I have developed a lump at the site of the incision. I will comment again after monday.

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