Patient education: Breast-conserving surgery (The Basics)

What is breast-conserving surgery? — This is a way to treat breast cancer. It removes the cancer and a section of healthy tissue around it (called a "margin") from the breast. It is sometimes called a "lumpectomy" or "partial mastectomy" (figure 1). Also, doctors often remove 1 or more lymph nodes under the arm.

If you choose this option, you will keep your breast. But you will probably need to have radiation therapy after surgery. The goal of radiation is to kill any cancer cells that might still be in your breast area.

In some cases, your doctor might suggest that you have some kind of cancer treatment before surgery. This can sometimes shrink the tumor or give the doctor more treatment options. If you do get cancer treatments before surgery, your doctor will place a small titanium clip into your breast. This marks where the tumor was in case it shrinks and is hard to find.

This article focuses on breast-conserving surgery, not on other treatments or lymph node surgeries.

How do I prepare for breast-conserving surgery? — The doctor or nurse will tell you if you need to do anything special to prepare. Before your procedure, your doctor will do an exam. They might send you to get tests, such as:

●Lab tests

●Mammogram or other imaging tests – These create pictures of the inside of the body.

●Biopsy – This is a procedure to remove a small sample of tissue for testing.

Your doctor will also ask you about your "health history." This involves asking you questions about any health problems you have or had in the past, past surgeries, and any medicines you take. Tell them about:

●Any medicines you are taking – This includes any prescription or "over-the-counter" medicines you use, plus any herbal supplements you take. It helps to write down and bring a list of any medicines you take, or bring a bag with all of your medicines with you.

●Any allergies you have

●Any bleeding problems you have – Certain medicines, including some herbs and supplements, can increase the risk of bleeding. Some health conditions also increase this risk.

You will also get information about:

●Eating and drinking before your procedure – In some cases, you might need to "fast" before surgery. This means not eating or drinking anything for a period of time. In other cases, you might be allowed to have liquids until a short time before the procedure. Whether you need to fast, and for how long, depends on the procedure you are having.

●Lowering the risk of infection – In some cases, you might need to trim (not shave) your body hair before your procedure. You might also need to wash the area with a special soap.

●What help you will need when you go home – For example, you might need to have someone else bring you home or stay with you for some time while you recover.

Ask the doctor or nurse if you have questions or if there is anything you do not understand.

What happens during breast-conserving surgery? — When it is time for the procedure:

●You will get an "IV," which is a thin tube that goes into a vein. This can be used to give you fluids and medicines.

●You will get anesthesia medicines. This is to make sure that you do not feel pain during the procedure. Types of anesthesia include:

•Regional – This type of anesthesia blocks pain in 1 area of your body, such as an arm, a leg, or the lower half of your body. If you get regional anesthesia, you might be awake. Or you might get medicines to make you relax and feel sleepy, called "sedatives."

•General – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during the procedure. If you have general anesthesia, you might get a breathing tube to help you breathe.

●You might get medicines to help control pain after the procedure.

●The doctors and nurses will monitor your breathing, blood pressure, and heart rate during the procedure.

●The doctor will make a cut (incision) in the skin over your breast. Then, they will remove the tumor and a small amount of breast tissue. They might need to make another incision if they need to remove lymph nodes under your arm and around your breast.

●They will close your incisions and cover them with clean bandages.

●The procedure takes about 1 hour.

What happens after breast-conserving surgery? — After your procedure, you will be taken to a recovery room. The staff will watch you closely as your anesthesia wears off. Most people can go home the same day.

As you recover:

●You might feel groggy or confused for a short time. You might also feel nauseous or vomit. The doctor or nurse can give you medicine to help with this.

●If you had a breathing tube, you might have a sore throat. This usually gets better quickly.

●The staff will help you get out of bed and start moving around when you are ready.

●You will get medicine if needed to help with pain. You might need other medicines, too.

●When you are ready to eat, you will start with clear liquids. Then, you can start eating as you are able. You might feel better if you start with bland foods.

What are the risks of breast-conserving surgery? — Your doctor will talk to you about all of the possible risks, and answer your questions. Possible risks include:

●Needing to have more tissue removed or a mastectomy (surgery to remove whole breast) – This might be the case if there are cancer cells at the edge of the tissue that was removed.

●Collection of fluid or blood under the skin

●Infection

●Pain

●Nerve injury

●Fluid buildup in your arm or hand if lymph nodes were removed

●Recurrent breast cancer

What else should I know? — Before you go home from the hospital, make sure that you know what problems to look out for and when you should call the doctor. Make sure that you understand your doctor's or nurse's instructions. Ask questions about anything you do not understand.

More on this topic

Patient education: Breast-conserving surgery – Discharge instructions (The Basics)
Patient education: Choosing surgical treatment for early-stage breast cancer (The Basics)
Patient education: Mastectomy (The Basics)
Patient education: Breast reconstruction after mastectomy for cancer (The Basics)
Patient education: Breast cancer (The Basics)

Patient education: Surgical procedures for breast cancer — Mastectomy and breast-conserving therapy (Beyond the Basics)
Patient education: Breast cancer guide to diagnosis and treatment (Beyond the Basics)