Lumpectomy – What to Expect During Your Lumpectomy

Lumpectomy is one type of breast-conserving surgery, and is usually done as an outpatient procedure. Your surgeon will remove just the breast lump and a margin of tissue around the lump. You will keep most of your breast, and you will have a scar at the incision site.

Before your lumpectomy, the hospital or surgical center may ask you to come in for a pre-operative appointment. It’s a good idea to take time for this appointment, so you can get most of the paperwork out of the way before surgery, and ask questions that you may have. Bring your insurance card with you and identification such as a driver’s license. Be prepared to make a payment to the hospital, or ask them what amount will be due on the day of surgery. Give the nurse a list of your current medications, and be prepared to answer questions about your health history. If you are allergic to particular medications, let them know. You may be asked to sign consent forms for the surgery as well as possible blood transfusions.

You can ask for pre-medication to prevent nausea and vomiting from the anesthesia, if you think that may be needed. A Scopolamine patch behind your ear can also help prevent nausea. Make sure that your request is noted in your chart. Ask questions about billing –- will the hospital, surgeon, and anesthesiologist bill you separately or inclusively? Will your health insurance be compatible with their services? If your insurance is not accepted by one of those providers, can a compatible provider be found for you? How should you dress on the day of surgery? Should you have a designated driver? Who should you call during recovery, if a problem comes up? Jot down the answers to these questions, so you can be prepared.

You will be required to avoid food and drink for 8 to 12 hours before surgery. When you arrive for surgery, you will check in and begin preparations. You will change into a hospital gown, and your own clothes will be stored. A nurse will take your vital signs. In some cases, your skin may be marked to indicate where the incision should be started. Your anesthesiologist will meet with you and talk about what anesthetic will be used, and you may be given pills (or a patch) to help prevent nausea. A nurse will start an intravenous line (IV) for fluids and anesthesia. The IV needle will be inserted in your hand or arm, and taped into place.

If your surgeon wants to check your lymph nodes during your lumpectomy, you will need to have lymphoscintigraphy in preparation for a sentinel lymph node biopsy. And if your breast lump is too small to be easily felt, a wire localization procedure may be done to help your surgeon locate and remove the lump.

Most lumpectomies are done while you are under general anesthesia (asleep). Once the anesthesia is started, your surgeon will make the incision using a special heated scalpel. The heated scalpel cauterizes your tissue and helps prevent bleeding during your surgery. Your incision will be curved, following the natural contour of your breast, to allow it to heal properly. The breast lump will be removed along with a margin of tissue. The cancerous tissue is then sent to the pathology lab for examination. If needed, a surgical drain will be placed to help remove fluid that collects in your surgical site. Your incision will be closed with stitches or staples, and dressed (bandaged) to keep it clean, and apply pressure to the wound.

While you are still under the effects of anesthesia, you will be moved to the Recovery room, where your vital signs will be monitored. Since a lumpectomy is usually done as an outpatient procedure, you will be given instructions on self-care, and allowed to return home. If you need special attention after the surgery, or if you’ve had other procedures done as well, you may be moved to a hospital room for the night.

If you have been given pain medication, and feel the need for it, take it as directed. The pain will lessen, and soon you won’t need the extra pills. Keep your bandages clean and dry. If required, wear a sports bra over the bandages, to maintain pressure over the incision. Follow your directions in caring for your surgical drain, if you have one. Rest while you are recovering, and plan on having someone do the lifting and driving for you until you feel back to normal. When your surgeon says its okay, start doing arm exercise to prevent arm and shoulder stiffness. Keep your follow-up appointments.

After your lumpectomy, if the pathology report states that your lump has cancer cells in the margin of tissue around it, your surgeon may need to remove a bit more tissue. This is done to ensure that all of the cancer has been removed, and your risk of recurrence is lowered. This is a separate surgical procedure for removing extra marginal tissue, and it is called re-excision. If the re-excision will make your breast significantly smaller or undesirably shaped, your surgeon may ask if you would prefer a mastectomy, and possibly reconstruction.