Lumpectomy is the surgical procedure in which only a part of the breast is removed to eliminate a breast cancer. Lumpectomy is different than mastectomy, which involves removal of the entire breast. In addition to removing the breast cancer, lumpectomy also requires removal of a narrow rim of healthy tissue surrounding the cancer to ensure that the entire cancer has been completely removed. We call this extra rim of normal tissue a “clear” margin. Another name for lumpectomy is “partial mastectomy”. Lumpectomy usually requires radiation of the breast to reduce the risk of cancer recurrence in the remaining treatment.
Whenever possible, Dr. Holmes makes lumpectomy incisions in discrete areas of the breast so that the incisions are not obvious. This includes incisions at the edge of the areola, in the armpit or in the natural skin crease under the breasts.
The combination of lumpectomy and radiation achieves the same cancer control and survival as mastectomy, but with fewer side effects and faster recovery. Therefore, lumpectomy and radiotherapy are preferred if the cancer is small enough to be removed completely with acceptable breast appearance.
Radiation is usually recommended to reduce the risk of cancer recurrence in the part of the breast that remains after lumpectomy. A 3-6 week course of daily whole breast radiation is the most widely available form of radiation for women treated with lumpectomy. A 5-day course of partial breast radiation can also be administered, usually given twice a day. Dr. Holmes is one of the few surgeons in Southern California who offers targeted intraoperative radiotherapy (TARGIT), a type of targeted radiation that can be administered as a single treatment entirely during surgery at the time of lumpectomy.
Most women diagnosed with early stage breast cancer are candidates for lumpectomy. The ability to perform a successful lumpectomy depends on the size of the cancer compared to the size of the breast, the location of the cancer in the breast, and the skill of the surgeon. We may sometime recommend chemotherapy prior to surgery to shrink a cancer and make it more amenable to lumpectomy.
You may be a candidate for lumpectomy if you meet the following criteria:
The goal of breast cancer surgery is to remove the cancer surrounded by a rim of normal tissue. The main challenge of breast cancer surgery is that some parts of the cancer might not be detectable during surgery using standard procedures. About 15-30% of women in the U.S. require multiple surgeries to completely remove breast cancer.
To achieve complete tumor removal, Dr. Holmes uses multiple strategies to improve the odds of a successful lumpectomy, resulting in an exceptionally low (5-10%) rate of repeat surgery. These strategies include:
The MarginProbe device is a special handheld tool that may be used to evaluate the entire surgical specimen margin during surgery, allowing additional tissue to be removed and rechecked at that time. Each device can obtain up to 125 readings.
Multiple studies have shown that the MarginProbe device reduces the rate of positive margins by 50%! It also reduces the need for repeat surgery by 50%!
Dr. Holmes is an expert in oncoplastic surgery, an advanced approach to breast cancer surgery that utilizes plastic surgery procedures to improve cancer removal and breast appearance after lumpectomy. For example, with oncoplastic surgery, breast cancer surgery can be combined with breast reduction or breast lifts of both breasts to improve breast appearance and symmetry--procedures usually covered by insurance. In 2017, Dr. Holmes served as Co-Chair of the American Society of Breast Surgeon’s Oncoplastic Surgery Training Course, responsible for teaching breast surgeons how to perform oncoplastic surgery procedures.