Breast lump removal (lumpectomy)

Published by Bupa's Health Information Team, October 2010.

This factsheet is for people who are having a breast lump removed, or who would like information about it.

There are several different types of breast lump. Most of them aren't cancerous. Breast lump removal (lumpectomy) may be recommended if a lump is cancerous or if it's causing severe discomfort.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About breast lumps

Breast lumps are very common and most (at least nine out of 10) are benign and not cancerous. Many women will experience one or more breast lumps at some time in their lives. Most benign lumps are:

• cysts - a sac filled with fluid - these are usually drained in the clinic and rarely need to be removed
• fibroadenomas - fibrous and glandular tissue
• breast changes caused by hormones - for example, before a period.

Breast lumps can occur in men too, although they are far less common.

What are the alternatives?

If you have a benign lump, you may have vacuum-assisted core biopsy (VACB) to remove the lump.

If you have a cancerous lump, your treatment will depend on a number of factors, such as whether or not you have been through the menopause, what type of cancer you have and how advanced it is, and whether your cancer has spread. If your lump is large or has spread, you may need to have your whole breast removed (mastectomy) or part of your breast removed (quadrantectomy).

Preparing for a breast lump removal

Your surgeon will explain how to prepare for your operation. For example, if you smoke, you may be asked to stop because smoking increases your risk of getting a chest or wound infection, which can slow your recovery.

Lumpectomy is usually done under general anaesthesia. This means you will be asleep during the operation. You may have the operation and go home the same day, or you may need to stay in hospital for a few days.

Sometimes breast lumps are removed under local anaesthesia. The injection of anaesthetic completely blocks feeling in the area around your breast lump and you will stay awake during the operation. You may be given a sedative with a local anaesthetic. This relieves anxiety and helps you to relax.

If you're having general anaesthesia, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it's important to follow your surgeon's advice.

Bring in a soft, supportive bra to wear after surgery. Your surgeon or nurse will advise you about the most suitable type of bra. Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during a breast lump removal

Your surgeon will make a small cut in your skin over or near the lump, or in an area where the scar won't be obvious (for example close to your nipple or in the crease under your breast). He or she will cut the lump away along with a section of healthy tissue around it. This is called wide local excision and is done to try and make sure that all the cancerous cells are removed.

Your surgeon will close the cut with fine stitches. He or she will usually place a dressing over the wound. The lump (and healthy tissue) is sent to a laboratory for testing.

If the lump is large, your surgeon may also reconstruct your breast during the operation. This is done by moving muscle into the space the lump has been removed from.

What to expect afterwards

You may need to rest until the effects of the anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off.

Your nurse will give you advice about caring for your healing wound, hygiene and bathing before you go home. You may be given a date for a follow-up appointment.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours. The length of time your dissolvable stitches will take to disappear depends on what type you have. However, for this procedure they should usually disappear in about seven to 10 days.

Recovering from a breast lump removal

If you need pain relief, you can take over-the-counter painkillers such as paracetamol or ibuprofen. Always read the patient information leaflet that comes with your medicine and if you have any questions, ask your pharmacist for advice.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

After the operation, your wound may feel sore and you may find it more comfortable not to wear a bra. When the pain improves, you should wear a supportive bra.

Your nurse or physiotherapist may give you some exercises to do to prevent stiffness in your arm and shoulder.

Don't carry or lift anything heavy, or drive, while your wound is healing. This is likely to be for about 2 weeks.

What are the risks?

Breast lump removal is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted but mostly temporary effects of a successful procedure.

Side-effects of breast lump removal include:

• bruising and some swelling - this should improve as your wound heals
• numbness or pins and needles
• scarring - you will have a scar but this should gradually fade

Complications

This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, infection, excessive bleeding or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Specific complications of breast lump removal are uncommon, but can include:

• an unevenness in the size and shape of your breast
• a temporary build up of fluid under your wound or in your arm (called a seroma) - this is more likely to happen if you have had breast reconstruction
• the breast lump may come back in the future and need further surgery or treatment

The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.

For answers to frequently asked questions on this topic, see Common questions.

For sources and links to further information, see Resources.