What to expect during a breast lump removal
According to the support organization Breastcancer.org, eight out of 10 lumps that occur in the breast are not cancerous. Nevertheless, people should seek medical help if a new lump appears or if an existing lump changes.
Often, the lump does not need treatment but, sometimes, if a person needs treatment, doctors may recommend surgery. This kind of breast surgery is known as a lumpectomy.
In this article, we look at the reasons for the surgery and what people can expect before, during, and after the procedure.
Finding a breast lump can be worrisome, but most lumps are not cancerous.
There are several reasons why a person might need a lumpectomy.
Sometimes, a surgeon will carry out a biopsy to test a sample of tissue. At the same time, they might remove a small lump that looks suspicious.
The outlook after surgery depends on several factors, including the type of lump that the surgeon finds and the stage of the cancer if a lump is malignant.
There are different causes for lumps in the breast. Not all of them are cancer.
Cysts: These harmless growths in the breast tissue tend to occur with hormonal changes, such as the start of a menstrual period. A surgeon may use a needle to drain the fluid that usually fills a cyst. But after draining, cysts can reoccur.
Fibroadenoma and fibrocystic breasts: There conditions involve hardening and thickening of the tissue within the breast. The tissue is usually harmless.
Intraductal papillomas: This is when hard, rubbery, lumps form in the milk ducts. These are also usually harmless.
Benign tumors: These solid growths are not cancerous or dangerous. They can be uncomfortable, and they can sometimes cause leakage from the nipples, depending on their location. Doing a biopsy and examining the cells from the tumor under a microscope is the only way to determine if it is cancerous or benign.
Hormonal changes: The breasts change over time and during the menstrual cycle. Lumps may come and go regularly. Checking the breasts at the same time each month can help a person keep track of any change that is unusual.
Fatty lumps that develop after a trauma, and the use of some medications, are other causes of breast lumps.
When to see a doctor
Diagnostic tests for a breast lump include ultrasound.
It is vital for a person to see a doctor to find out which type of lump they have in their breast. They can then begin treatment early, if necessary.
Someone who has a low risk for breast cancer may only need to monitor the lump and return periodically to check on it.
However, a doctor may recommend either a biopsy or more extensive surgery if there is any chance that the lump may be malignant or if it causes pain.
What happens in a biopsy?
A biopsy involves removing a small amount of the lump to look for its cause. Doing a biopsy is the only way to diagnose breast cancer or other conditions definitively.
The American Cancer Society describe the following types of biopsy:
Fine needle aspiration biopsy: The doctor inserts a small needle into the lump and removes a few cells for testing.
Core needle biopsy: The doctor uses a slightly larger needle to remove three to six small cylinders of tissue from the breast. Specialists then look at the samples under a microscope.
Surgical biopsy: A surgeon makes a cut into the breast to remove either a small amount of the abnormal tissue or the entire lump. Removing the entire lump is known as an excisional biopsy.
Lymph node biopsy: The doctor takes tissue from the lymph nodes under the arm to check for cancer cells.
An excisional biopsy is also known as a breast lump removal or a lumpectomy.
A lumpectomy removes only the abnormal tissue and a small amount of surrounding tissue from the breast. It leaves the rest of the breast intact.
A surgeon can carry out several types of procedure to remove a breast lump or, in some cases, the entire breast.
The surgeon will discuss appropriate options with the patient. The procedure will depend on the size and location of the tumor, breast size, whether cancer has spread, and the wishes of the individual.
Types of surgery
Surgery may be an inpatient or outpatient procedure. It may leave a small scar.
A lumpectomy is when most of the breast tissue stays in place. In some cases, a more invasive intervention is necessary.
If doctors suspect cancer, a surgeon will remove lymph nodes that are close to the breast tumor to look for any evidence that cancer has spread.
When the surgeon removes a cancerous tumor, they must be sure that they have removed all the cancer cells.
The surgeon will initially take a small amount of tissue that surrounds the tumor, known as the border, for examination under a microscope.
If there are no cancer cells in the border, this is considered a healthy or clear margin.
If there are cancer cells in the border, further surgery may be necessary to remove the rest of the cancer.
A quadranectomy is another type of breast-saving surgery, though less common than a lumpectomy.
Around a quarter of the breast, including the tumor, is removed. Reconstructive surgery to replace the removed tissue may be an option after having a quadranectomy.
A mastectomy is the complete removal of the breast, nipple, and all of the breast tissue.
A radical mastectomy also removes the muscles that make up the chest wall.
The surgeon may carry out reconstructive surgery to create a new breast, either at the same time or a later date after a mastectomy.
What to expect
A lumpectomy is usually an outpatient procedure. It can take place either in the hospital or an outpatient surgical center.
If a mastectomy is necessary, it will usually take place in the hospital, because the procedure and recovery are more complex.
People who use certain medications, such as aspirin and other blood thinners, may need to stop taking these before surgery, so they reduce the risk of bleeding. A doctor will advise if this is necessary.
People should not eat or drink for at least 8 to 12 hours before surgery, and they should make arrangements for a ride home.
If the lump is difficult to locate within the breast tissue, a radiologist may need to place a marker in the lump and a thin guide wire, leading from the surface of the breast into the lump. This makes it easier for the surgeon to find the lump during surgery.
Typically, the person will meet with the surgeon a few days to a week before they have one of these procedures so they can discuss any additional instructions that may be necessary.
Depending on the surgery, the medical team may use a local or general anesthesia.
The surgeon will usually operate with an electric knife that reduces the risk of bleeding. They typically make a curved incision in the breast.
Sometimes, they will fit a drainage tube to remove any excess fluid that might build up in the place where the lump was after the surgery.
Following the procedure, the surgeon will stitch the incision and apply a dressing.
As with all surgical procedures, breast lump removal can carry some risks.
These may include:
- scar tissue
- change in appearance of the breast
Rest is an important part of the recovery process.
Recovery will depend on the type of procedure. The surgeon will give detailed instructions on how and when a person should have a follow-up appointment for further care.
The doctor may give the individual a prescription for some pain medication and instructions about caring for the dressing and follow-up appointments.
Sometimes, the drainage tube remains in place until the follow-up appointment.
Depending on the extent of the procedure, aftercare may include:
- taking sponge-baths instead of showers while stitches are still in place
- wearing a support bra or sports bra
- arm exercises that the surgeon may recommend
People should look out for increasing pain, swelling, redness, and other signs of infection. If they notice these, they should contact your doctor.
There may be some itching and sensitivity as the nerves grow back after surgery. This may go away in time, or a person may become used to the different feeling.
After removing the breast tissue, the surgeon will send it to a pathologist, who will examine it under a microscope to confirm the diagnosis. The doctor will share this information after receiving the results. They will discuss what the results mean and what will happen next.
It is not always possible to detect a lump or other changes in the early stages of breast cancer. For this reason, it is important to consider screening.
The American College of Physicians recommend asking a doctor about routine screening from the age of 40 years. They also recommend routine screening every 2 years for women ages 50–74 with an average risk of breast cancer.
Other authorities, such as the American Cancer Society, make different recommendations.
Individuals should ask their doctor about the best option for them.
Although it can be frightening to find a lump in the breast, the cause is often not cancer.
However, anyone who finds a lump should see a doctor promptly to obtain an accurate diagnosis and start early treatment if necessary.
Screening can help people find changes in the early stages of breast cancer, when there is a strong chance of treating it effectively.