Women diagnosed with breast cancers that are small enough and can leave surrounding healthy tissue behind are candidates for lumpectomy options. The amount is relative, as someone with a smaller breast may not tolerate much tissue removal before it appears disfigured, while someone with a larger breast may have quite a large area of disease with little to no noticeable defect after it is removed.
Bedford Breast Center is one of the few medical centers that focuses both on cancer treatment and aesthetic preservation. We have techniques that utilize minimally-invasive and hidden scar approaches, along with breast lift and reduction techniques to optimize results. Also referred to as breast-conserving surgery (BSC), a lumpectomy removes the cancer while leaving as much of the breast intact as possible. We target the breast tumor and a thin layer of healthy tissue surrounding the tumor during this surgery to ensure we remove all of the abnormal tissue.
Am I A Candidate for A Lumpectomy?
A lumpectomy procedure can be an excellent option for women who have smaller cancer tumors or larger breasts. The breast surgeons at Bedford Breast Center in Beverly Hills are happy to discuss your breast cancer treatment options and tailor your care to your specific needs. We have expertise in assessing how much breast tissue we will need to remove and where to place incisions to ensure a healthy and cosmetically appealing outcome. The top priority in breast cancer treatment is to eradicate cancer. However, we realize that your appearance is a critical component in your healing process and will do everything we can to preserve as much of your natural breast as possible.
Lumpectomy vs. Mastectomy
In a mastectomy, the tissue that comprises the breast (and encompasses the cancerous tissue) is removed. In most patients, healthy skin and nipples are left behind, but there’s no attempt to preserve any residual breast tissue. However, microscopic amounts of tissue are frequently embedded in the skin and soft tissues that are left behind. This is considered safe and an expected part of preserving the cosmetic aesthetic qualities of the breast during reconstruction.
During lumpectomy, the cancer site is removed along with a (cancer cell-free) margin around the area to minimize the risk for recurrence. Advantages include:
- Smaller incisions
- Quicker recovery
- Preservation of the appearance and sensation of the breast
For larger masses, we also perform fat grafting and oncoplastic breast reduction when necessary, to maintain the breast’s natural shape and appearance.
When the mass is too large or the breasts are too small to allow for a lumpectomy, patients may require a mastectomy instead of a lumpectomy to remove the cancer. Mastectomy patients will find our techniques and results to be cosmetically superior to other practices – as we offer nipple-sparing mastectomy for most patients undergoing mastectomy and breast reconstruction.
In this nipple-preserving procedure, the mass is removed leaving the breast skin and nipple intact. Our SWIM flap breast reconstruction, co-developed by our own Dr. Heather Richardson, and Dr. Lisa Cassileth – removes the cancerous tissue and the plastic surgeon then creates a breast from the remaining skin and tissue. SWIM stands for skin-sparing, wise pattern internal mammary perforator and creates a natural look without the need for implants or free flaps.
Whether you undergo a lumpectomy or mastectomy, we will ensure you receive the safest, most effective treatment with the best possible cosmetic result.
Assessment of Your Treatment Options
When we identify a cancerous area, we must first collect information about the size or area of abnormal tissue before discussing treatment options. Only then can we make the best judgments about how much tissue we need to remove and how much we can safely leave behind. The type of cancer and amount of abnormality also dictates whether additional treatments are required.
For some patients, medicine administered orally or through the bloodstream is needed to ensure the cancer does not return. For others, radiation is projected onto the cancer site to ensure complete eradication and the lowest possibility of recurrence. Radiation changes the breast somewhat, so any breast reconstruction must wait until the final shape is determined. We will sit down with you to review why some cancers require additional treatments and some do not.
For some patients with breast cancer, the area of the cancer may be only a minimal part of their breast, and the decision can be made to save healthy breast tissue. If the area is small and the patient is happy with her breast appearance, a simple lumpectomy may be performed where only the cancer site is removed without changing the appearance of the breast. For other patients, however, the area of cancer may be large enough to significantly impact the size and shape of the breast. If the patient feels they might be unhappy with the aesthetic surgical outcome, our surgeons may decide to incorporate cosmetic surgery techniques to lift or reduce the breast while simultaneously removing the cancerous tissue. Combining the approaches that both take rearranging breast tissue into account to improve or maintain the appearance of a healthy breast while removing the cancerous tissue is called the oncoplastic technique. This comes from the term “onco,” meaning cancer, and “plastic,” meaning maneuvering tissue.
For small or uncomplicated situations, the procedure can be performed solely by the breast surgeon to remove the cancer; however, if the breast surgeon takes out 20% or more of the breast tissue, they will team up with a plastic reconstructive surgeon to provide an optimal aesthetic result.
Diagnosing the Cancer
Our pathology colleagues help us make the correct cancer diagnosis and the best treatment approach once the initial surgery is completed. We require tissue analysis under the microscope to ensure adequate margins or healthy tissue surrounding the cancer. Because these changes cannot be seen with the eye or felt with the hand, we cannot make any promises at the time of surgery that all cancerous tissue is gone.
Once the information from the tissue analysis becomes available, we can guide you through the next steps in your cancer treatment process. Sometimes, additional surgery or even mastectomy is required after breast cancer lumpectomy surgery if we discover that cancerous tissue remains.
Creating the Best Result
Typically we place lumpectomy incisions in natural creases and lines in the body, such as near the areola, in the armpit, or under the breast. We pride ourselves in creating a surgical plan that will consider your concerns for cancer removal while leaving behind healthy tissue in a pattern that lacks tell-tale signs of cancer surgery. Suppose the amount of tissue required to ensure removal of all disease would cause deformity of the breast. In that case, we are well-versed in working with advanced reconstruction techniques and offer oncoplastic breast reduction surgery for women who prefer the most natural results.
Learn more about Lumpectomy surgery by visiting mskcc.org.
Your Lumpectomy Recovery
Lumpectomy recovery varies from woman to woman. Most women will return home the same day as the surgery. We will prescribe pain medication to keep you comfortable after your procedure and possibly antibiotics if infection is a concern. We will also give you instructions on caring for your bandages and incision once you go home. Incision care is critical to ensure scarring is minimal as the wound heals.
For the first few days after your surgery, you might experience:
- Pinching sensations
Downtime varies from 2-10 days depending on the extent of tissue removal. We will schedule follow-up visits to monitor your healing and ensure no complications arise.
ULTRA: Ultrasound Lesion Therapeutic Removal Alternative
Women diagnosed with a non-malignant lump in the breast do not necessarily have to undergo lumpectomy surgery. Still, many are uncomfortable with the presence of even a benign mass within their breast. They may not want to monitor the mass for changes continually and would rather have it removed but are reluctant to undergo surgery. In such cases, a non-surgical lumpectomy procedure may be an excellent option.
Our proprietary ULTRA (Ultrasound Lesion Therapeutic Removal Alternative) technique uses a small extraction device inserted through a minor incision made between the breast and nipple to minimize visible scarring. The physician guides the extraction device using ultrasound imaging so that we can locate the targeted mass instantly. We perform the ULTRA procedure using local anesthesia to ensure the patient is comfortable throughout. We perform this non-surgical lumpectomy in our office, and patients go home the same day. You may return to work and routine, non-strenuous activities the next day.
A non-surgical lumpectomy procedure is only appropriate for patients with non-cancerous growths. Patients with masses that may be cancerous or become cancerous may need to undergo a fine needle aspiration biopsy, core-needle biopsy, or lumpectomy surgery.
Fat Grafting After Lumpectomy
Once you complete your breast-conserving treatment plan, we typically allow several months for the healing process to take place. If you are not fully satisfied with the final appearance, we have many tools to improve the breast shape or contour. Fat grafting, or lipo modeling, is one common technique that produces outstanding results. During this procedure, we remove fatty deposits from other areas of the body via liposuction. The tummy or thighs are familiar places to harvest the fat, placed in tiny droplets into strategic locations in the breasts to add shape and fullness. Because we use your fatty tissue, it has a very natural and soft appearance.
Most patients who have a lumpectomy do not require follow-up plastic surgery; however, it is an option if desired. Any surgery in this situation is considered “reconstruction,” not “cosmetic“ surgery, and covered by insurance.
Contact our Medical Clinic to Learn More About Breast Lumpectomy
At the Bedford Breast Center, we offer superior lumpectomy results. Our medical clinic provides services to women at our convenient Los Angeles breast center as part of our comprehensive care approach that focuses on removing the fear and confusion of breast cancer treatment. Our goal is to be there for our patients during this incredibly stressful time. If you would like more information about getting the most skillful, effective, and compassionate breast cancer lumpectomy Los Angeles has to offer, please call (310) 278-8590 today or contact us online to schedule an appointment.