Lumpectomy: Who’s a Candidate?

Dr. Shannon Lehr is a board certified and fellowship trained breast surgeon with 20 years of experience caring for patients with breast cancer.  Dr. Lehr is the Medical Director of Breast Care Consultants of Northern Virginia and the Inova Breast Care Program at Inova Loudoun Hospital. 

A lumpectomy (also called a partial mastectomy) is considered “breast-conserving” surgery because only the tumor and a surrounding area of normal breast tissue (called the margin) are removed.  Most commonly, lumpectomy is followed by a course of radiation therapy which ensures that any cancer cells in the remaining breast tissue have been killed.  Lumpectomies are often an attractive surgical option because it allows women to keep their own breast.

It is estimated that at least 50% of women with breast cancer are good candidates for this procedure.  Studies have shown that women have the same chance of surviving breast cancer whether they choose to have a lumpectomy or a mastectomy.  If a patient chooses lumpectomy with radiation, however, there is a slightly higher chance that the cancer can come back within the breast. This is known as a local recurrence.

The location, size and type of tumor and the size of the patient’s breast are of primary importance when considering breast cancer surgery options.  There are a number of factors that may make breast-conserving surgery not suitable for a breast cancer patient:

• Size and location of the tumor. The tumor itself may be too large or located in an area where it would be difficult to remove with positive cosmetic results. In some instances, women with these types of tumors may be able to undergo chemotherapy or endocrine therapy before surgery with the hope of decreasing the tumor size. This is known as neoadjuvant treatment and ultimately allows the surgeon to remove a much smaller amount of tissue during the lumpectomy.
• Multifocal or multicentric disease. If two or more areas of cancer are found in one breast, this is known as multifocal or multicentric disease.  This scenario may not allow the tumor to be removed as a single lump, and in that case a mastectomy would be required.
• Radiation therapy. Since radiation therapy is an important part of breast conservation , women who are not candidates for post-operative radiation typically cannot undergo a lumpectomy for their breast cancer.  Patients who have already undergone radiation in the breast/chest area, those with connective tissue diseases such as scleroderma, and/or women who would be pregnant at the time of radiation therapy should NOT be advised to consider lumpectomy.
• Positive margins. If the outer edges of the removed breast tissue contain cancer cells (a positive margin), additional surgery (called a re-excision) is usually recommended in an attempt to remove the remaining cancer.  If it is not possible to clear the margins with re-excision(s), then a mastectomy is usually necessary for successful treatment.

The patient’s lifestyle, preferences, family history and psychological outlook should also all be taken into account when treatment decisions are being made. Choosing the appropriate surgical treatment involves a lengthy and detailed discussion between you and your doctor to decide together what is best for your situation.

Learn more about the Inova Breast Care Program at Inova Loudoun Hospital and the Inova Schar Cancer Institute — Peterson Family Breast Center which is slated to open in March 2018.