What is 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 usually 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.
Why might I need breast-conserving surgery?
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 doctor to recommend BCS.
What are the risks of breast-conserving surgery?
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 medical condition. Be sure to discuss any concerns with your doctor before the surgery.
Reconstructive surgery after breast-conserving surgery
Talk with your doctor 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 doctor before surgery to know what to expect, and what your options are.
How do I get ready for breast-conserving surgery?
- Your doctor will explain the procedure to you and give you a chance to 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 doctor will take your medical 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.
- You will be asked to not eat or drink anything (to fast) for some time 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 your relax (a sedative) before the procedure.
Your healthcare provider may have other instructions for you based on your medical condition.
What happens during breast-conserving surgery?
BCS may be done on an outpatient basis. This means you go home the same day. Or it may be done as part of your stay in a hospital. Procedures may vary depending on your condition and your doctor's practices.
Generally, BCS follows this process:
- You will be asked to remove clothing and given a gown to wear.
- An IV (intravenous) line may be started in your arm or hand.
- You will lie on your back on the operating table.
- 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.
- BCS may also be done under general anesthesia. You will be given medicine to put you into a deep sleep during surgery.
- Your heart rate, blood pressure, breathing, and blood oxygen level will be checked during the surgery.
- The skin over the surgical site will be cleaned with a sterile solution.
- 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.
- If the lymph nodes under your armpit are to be removed, a separate surgical cut may be made in or near the armpit.
- Breast tissue and any other tissues that are removed will be sent to the lab for exam.
- A drainage tube may be inserted into the affected area.
- The skin will be closed with stitches or adhesive strips.
- A sterile bandage or dressing will be placed over the site.
What happens after breast-conserving surgery?
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.
Once you are home, keep the surgical area clean and dry. Your doctor 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 doctor. Aspirin and some other pain medicines may increase your chance of bleeding. Be sure to take only recommended medicines.
Your doctor 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, avoid doing anything strenuous. Don’t do things that involve using your arm too much, such as cleaning windows or vacuuming for a long time. Your doctor 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 doctor will advise you about this, depending on your particular situation.
Tell your doctor if you have any of the following:
- Fever or chills
- Redness, swelling, or bleeding or other drainage from the incision site
- Increased pain around the incision site
- Swelling or numbness or tingling of the affected arm, if lymph nodes were removed
Your doctor 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
- Avoid 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.
- Avoid sunburns
- Use a clean razor to shave under your arm
- Avoid wearing 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
- Avoid insect bites or stings by using insect repellents or wearing long sleeves
Your doctor 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 will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure
January 16, 2018
Breast conserving therapy. UpToDate., Lippincott Manual of Nursing Practice. StatRef., Complications in Breast Surgery. Newman LA. Surgical Clinics of North America. 87 (2007) 431-451.
Stump-Sutliff, Kim, RN, MSN, AOCNS ,Cunningham, Lu, RN