Breast-Conserving Surgery

Breast-conserving surgery (BCS) may be used as part of a treatment plan for breast
cancer. It is sometimes called a lumpectomy or a partial mastectomy.

During BCS, only the part of the breast that has cancer is removed. The cancer lump and some breast tissue around the lump are removed. How much of the breast is removed will depend on the lump’s size, and where it is located.

The surgeon may also remove some of the lymph nodes under your arm to find out if the cancer has spread there. Breast cancer often spreads to these lymph nodes. It can then spread to other parts of the body.

Radiation therapy is often given after BCS. This destroys cancer cells that may not
have been removed during surgery. In some cases, chemotherapy and radiation are both
given after BCS.

BCS may be done as part of treatment for breast cancer.

This surgery is an option for some women with a lump that is small and in 1 area. It’s also an option for many women with early stage breast cancers.

BCS
removes a smaller part of your breast. You may worry that this might make your cancer
more likely to return. But BCS can work just as well as surgery to remove the entire
breast (mastectomy). Studies show that women who have BCS followed by radiation therapy
have similar long-term survival rates as women who have a mastectomy. There may be other
reasons for your surgeon to recommend BCS.

All surgeries have some risk. Some possible complications of BCS include:

  • Short-term (temporary) breast swelling
  • A change in the size and shape of the breast
  • Hardness due to scar tissue that can form at the incision site
  • Wound infection or bleeding
  • Swelling (lymphedema) of the arm, if lymph nodes were removed

A clear fluid (seroma) is often present in the wound after BCS. This can be drained in the surgeon’s office and treated with compression if needed.

There may be other risks depending on your specific health condition. Be sure to
discuss any concerns with your healthcare team before the surgery.

Reconstructive surgery after breast-conserving surgery

Talk with your healthcare provider about how your breast may look after your
surgery. Depending on how much of the breast is removed, it may look different
afterward. Some type of reconstructive surgery may be an option. Or it may be
possible to make your other breast a little smaller so that both breasts look more
alike. The surgeon may even be able to do this during the BCS.

Talk with your healthcare team before surgery to know what to expect, and what your
options are.

  • Your healthcare provider will explain the procedure to you. Ask any questions that
    you might have.
  • You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.
  • Your
    healthcare provider will take your health history. He or she will also give you a
    physical exam. This is to be sure you are in good health before the surgery. You may
    also have blood tests or other tests.
  • Follow
    any directions you are given for not eating or drinking before the surgery. Your
    surgeon will give you specific instructions.
  • Tell your provider if you are pregnant or think you may be pregnant.
  • Tell your provider if you are sensitive to or allergic to any medicines, latex, tape, and anesthesia medicines (local and general).
  • Tell your provider about all the medicines you take. This includes both over-the-counter and prescription medicines. It also includes vitamins, herbs, and other supplements.
  • Tell your provider if you have a history of bleeding disorders. Let your provider know if you are taking any blood-thinning medicines, aspirin, ibuprofen, or other medicines that affect blood clotting. You may need to stop taking these medicines before the procedure.
  • You may
    be given medicine to help you relax (a sedative) before the procedure.

Your
healthcare provider may have other instructions for you based on your health
condition.

BCS may be done on an outpatient basis. This means you go home the same day. Or it may
be done as part of a hospital stay. Procedures may vary depending on your condition and
your doctor’s practices.

Generally, BCS follows this process:

  1. You will be asked to remove clothing and given a gown to wear.
  2. An IV (intravenous) line may be started in your arm or hand.
  3. You will lie on your back on the operating table.
  4. BCS may be done under local anesthesia. This means the area being operated on will be numbed. You will get medicine (sedative) in your IV before the procedure to help you relax. You will likely stay awake, but feel sleepy, during the surgery.
  5. BCS may also be done under general anesthesia. You will be given medicine to put you into a deep sleep during surgery.
  6. Your heart rate, blood pressure, breathing, and blood oxygen level will be checked during the surgery.
  7. The skin over the surgical site will be cleaned with a sterile solution.
  8. A small cut (incision) will be made over or near the breast tumor. The doctor will remove the lump or abnormality. He or she will also remove some of the normal breast tissue around it.
  9. If the lymph nodes under your armpit are to be removed, a separate surgical cut may be made in or near the armpit.
  10. Breast tissue and any other tissues that are removed will be sent to the lab for exam.
  11. A drainage tube may be inserted into the affected area.
  12. The skin will be closed with stitches or adhesive strips.
  13. A sterile bandage or dressing will be placed over the site.

In the hospital

After the procedure, you will be taken to the recovery room and watched closely.
Your recovery process will vary depending on the type of procedure done and the
anesthesia you are given. Once your blood pressure, pulse, and breathing are stable
and you are alert, you will be taken to your hospital room.

You will likely go home the same day or in 1 to 2 days after BCS.

At home

Once you are home, keep the surgical area clean and dry. Your healthcare team will
give you specific bathing instructions. If adhesive strips were used, they should be
kept dry. They often fall off in a few days.

The amount of pain you have will vary. It depends on the amount and location of
tissue removed during surgery. Soreness should decrease over time. Take a pain
reliever as advised by your healthcare team. Aspirin and some other pain medicines
may increase your chance of bleeding. Be sure to take only medicines advised by your
provider.

Your provider may instruct you to keep wearing a bra for support, for a period of
time.

You will likely go back to your normal activities in 2 weeks. In the meantime, don’t
do anything strenuous. Don’t do things that require using your arm too much. This
includes cleaning windows or vacuuming for a long time. Your provider will tell you
when you can start driving again and when you can go back to work.

BCS may be followed by radiation therapy. Your healthcare team will advise you about
this, depending on your particular situation.

Tell your provider if you have any of the following:

  • Fever
    or chills
  • Redness, swelling, or bleeding or other drainage from the incision site
  • More
    pain around the incision site
  • Swelling or numbness or tingling of the affected arm, if lymph nodes were
    removed

Your provider may give you other instructions, depending on your situation.

Arm care after lymph node
removal

Removing lymph nodes during BCS may affect how lymphatic fluid drains from your arm.
Problems with lymphatic drainage can cause swelling in your arm. You may also be at
greater risk for infection from injury to your arm. And there is a higher risk for
blood clots in your armpit veins after surgery to the area.

You will have to follow certain safety steps for the rest of your life after lymph
node removal. This will help prevent problems in the affected arm. These safety steps
include:

  • No
    needle sticks or IVs placed in the affected arm
  • No
    blood pressure measurements in the affected arm
  • Follow instructions about arm exercises carefully
  • Prevent injuries, such as scratches or splinters, to the affected arm
  • Raise
    (elevate) the arm, with your hand above your elbow, to help drain lymphatic
    fluid
  • Wear
    gloves when gardening or doing any activity where there is a risk for getting a
    cut on your fingers or hands. Also wear gloves when using strong or harsh
    chemicals, such as detergents or household cleaners.
  • Don’t
    get sunburns
  • Use
    a clean razor to shave under your arm
  • Don’t
    wear any tight items on the affected arm. This includes elastic cuffs, tight
    watches, or other jewelry.
  • Use
    your good arm or both arms to carry heavy packages, bags, or purses
  • Prevent insect bites or stings by using insect repellents or wearing long
    sleeves

Your healthcare provider may give you other instructions, depending on your
situation.

Before you agree to the test or the procedure make sure you know:

  • The name of the test or procedure
  • The reason you are having the test or procedure
  • What results to expect and what they mean
  • The risks and benefits of the test or procedure
  • What the possible side effects or complications are
  • When and where you are to have the test or procedure
  • Who will do the test or procedure and what that person’s qualifications are
  • What would happen if you did not have the test or procedure
  • Any alternative tests or procedures to think about
  • When and
    how you will get the results
  • Who to call after the test or procedure if you have questions or problems
  • How much
    you will have to pay for the test or procedure