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Lumpectomy & Lymph Node Evaluation

A lumpectomy, also known as partial mastectomy, is a surgical procedure that involves the removal of a cancerous lump from the breast.

The axillary lymph nodes reside under the armpit (axilla), and drain the breast tissue. Sampling involves either a node dissection (more than 4 nodes) or a sentinel node biopsy (usually between 1 and 3 nodes). This is done to determine if breast cancer has gone to the lymph nodes.

Risks of the Procedure

Complications are usually rare, but can include infection and bleeding or hematoma formation at the surgical site. Remember, we expect some temporary swelling and bruising of the remaining breast tissue.

Because we are removing a part of your breast tissue, the overall look, shape, and size of your breast can be affected depending on the size of the lump removed. Your nipple may point another way, and your breasts may not match as they did before the surgery.

In our experience, greater than 80% of patients find their cosmetic outcomes completely acceptable.

Swelling and bruising are very typical of any operation on the breast and good bra support can be helpful.

Complications involving the removal of lymph nodes include the risk of arm swelling (lymphedema), armpit numbness/soreness, decreased range of motion of that shoulder, and rarely nerve injury.

Some people may experience numbness/tingling along either incision. This is normal and may last for several months. Some numbness may be permanent.

The majority of patients with simple education and arm exercises return to their normal self/arm mobility within weeks after surgery.

Benefits of the Procedure

The cancer is removed without having to lose your breast.

Surgical Alternatives

The surgical options and recommendations are reviewed in detail prior to your procedure. If you have any questions in regard to your alternatives and feel you do not understand fully your options and physician recommendations, please do not hesitate to meet with your physician again to review these in detail.

The majority of women today have the option for breast conservation, but if deformity or other tumor characteristics limit this, a mastectomy may be recommended with/without breast reconstruction.

When to Call

Please call if you develop

  • A temperature greater than 101 degrees Fahrenheit
  • Bleeding from the incision that with 20 minutes of pressure and ice will not stop
  • Rapid or unusual swelling of the breast or under arm.
  • Whitish discharge, redness or warmth along incision.

Before the Procedure

Plan for your care and recovery after the operation. Find someone to drive you to and from surgery. Allow adequate time to rest and try to find help with your day-to-day duties.

If you smoke, it is advantageous to quit at least 2 weeks prior to the procedure, preferably 8 weeks. Smokers heal more slowly and are at higher risk of wound complications.

Try to stay as healthy as possible before surgery. Eat plenty of fresh fruits and vegetables.

Avoid taking aspirin, Motrin/Advil (Ibuprofen) or Aleve (naprosen) at least one week before surgery. Also avoid the use of Vitamin-E supplements, however, a daily multi-vitamin is okay.

Please notify your surgeon if you are taking Coumadin (warfarin) or Plavix.

Eat a light meal the night before and nothing by mouth after midnight or the morning of the surgery.

Overview of the Procedure

You will be given a general anesthetic, this puts you to sleep and prevents you from feeling pain. Sometimes you will be given a paravertebral nerve block which provides for post-operative pain control.

The surgeon will make a incision, usually about 1 to 4 inches long, to remove the lump and some surrounding normal breast tissue. This sample will be sent to pathology for evaluation. The exact length of the incision depends on the size of the cancer and how deeply in the breast it is located.

Some people may need to have the lymph nodes sampled in the under arm. This can be done by either a sentinel lymph node biopsy or axillary lymph node dissection.

When breast cancer spreads, one of the first places it goes is to the lymph nodes in the axilla. The procedure of sentinel lymph node sampling means to remove the first lymph node(s) in the chain to evaluate for cancer. If you and your surgeon have chosen sentinel lymph node biopsy, you will have two tracers injected to help in identifying the correct “sentinel” lymph nodes. The first is a radio-active isotope. This is injected 2-3 hours prior to the procedure in the nuclear medicine department. The second is a special blue-dye, also injected either around the cancer or nipple in the operating room once you are asleep. Through a separate incision close to the armpit, only the lymph nodes affected by these tracers are removed (usually 1-3). These nodes are examined for cancer immediately by the pathologist. If cancer is found, then an axillary lymph node dissection is performed.

If no cancer is found in the lymph nodes, the incision is closed. When a full axillary lymph node dissection is performed a drain will be left, usually for 4-7 days and typically one night will be spent in the hospital. Fortunately, most women can avoid a dissection with the sentinel lymph node biopsy. The accuracy of this procedure is known to be 93-97%.

The incisions will be closed with absorbable stitches. The skin will have steri-strips (small band-aids).

We recommend good bra support (sports bra) be worn 24 hours a day post-operatively for at least the first 3-4 days to help minimize swelling and bruising which may decrease pain.

After the Procedure

You will be given specific discharge instructions the day of surgery.

You may have a bulky dressing on. Leave this on for the first 24 hours. You may then take that off and you will see that you have steri-strips underneath. Leave these on until they fall off or until your follow-up appointment. It is okay to shower with these on.

Showering after 24 hours is OK. Avoid hot tubs, pools, or the bathtub for at least 7–10 days.

Generally, we recommend a supportive bra be worn the first few days and nights after the biopsy. This will minimize swelling and bleeding which will decrease pain.

Applying ice on and off for the first few days may also be helpful. Avoid the use of heat or heating pads.

We do recommend no lifting greater than 10 pounds after a lumpectomy until your follow-up appointment. If lymph nodes are sampled, we suggest no lifting greater than 10 pounds for three weeks.

Usually a prescription for pain medication will be given to you that day. You should not drive while on prescription pain medications.

Applying ice to the biopsy site, on and off, for the first 1-2 days, can help minimize swelling that might occur.

If you had a sentinel lymph node biopsy your urine may turn blue/green in the immediate post-operative hours. You may also notice some faint blue color to your eyes and skin of your breast. This will go away the next day.

If an axillary dissection has been performed, a drain will be in place and specific care instructions/arm exercises will be reviewed with you upon discharge.

If you have had lymph nodes sampled, do not use deodorant or antiperspirant, talc-powder, or a straight edge razor to shave for the first few weeks.

A follow-up appointment to see your doctor 5-7 days after your procedure is recommended. Please call the office is this has not yet been scheduled. It is at this time that the pathology from the surgery will be discussed.


 

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National Accreditation Program for Breast Centers (NAPBC)

The St. John Providence Breast Care Program is fully accredited by the American College of Surgeons. Our Breast Care Program was first accredited in 2009 and was just reaccredited in 2012. We are one of just nine programs in Michigan accredited through the NAPBC.

BECAUSE WE CARE

The St. John Providence Health System Breast Care Program is here for you. If you are a woman under or uninsured and need a mammogram we may be able to help. Call our Cancer Care Coordinators for more information at 1-866-246-4673.

Our position on the importance of mammography

St. John Providence Health System Breast Care Program is strongly opposed to the new recommendations from the United States Preventative Services Task Force (USPSTF). Our breast program will continue to follow the guidelines set forth by the National Comprehensive Cancer Network (NCCN) and the American Cancer Society (ACS).