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Lumpectomy Specialist

Dennis R. Holmes, M.D., F.A.C.S. -  - Breast Cancer Surgeon

Dennis R. Holmes, M.D., F.A.C.S.

Breast Cancer Surgeon located in Santa Monica, CA, Los Angeles, CA and Glendale, CA

Dr. Dennis R. Holmes is an internationally renowned breast cancer surgeon with locations in Beverly Hills, Santa Monica, Glendale, and Los Angeles, California. He is recognized as an expert in minimally-invasive breast surgery, including lumpectomies.

Lumpectomy (Partial Mastectomy) Q & A

What is a lumpectomy?

Lumpectomy (also called partial mastectomy) is the surgical procedure in which only a part of the breast is removed to eliminate a breast cancer.  This is in contrast with mastectomy, which involves removal of the entire breast.  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. 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 the natural skin crease under the breasts.

 

View Lumpectomy of Right Breast

 

What are the advantages of a lumpectomy compared to mastectomy?

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.

Why is radiation recommended after lumpectomy?  

Radiation is usually recommended after lumpectomy to reduce the risk of cancer recurrence in the parts of the breast that remains after lumpectomy.   A 3-week or 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 an expert in 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.  Targeted intraoperative radiotherapy has been proven to be equally effective as daily whole breast radiation for women with early stage breast cancer.  Although radiation is generally required after lumpectomy, there are special circumstances when radiation may be omitted, such as for stage 0 breast cancer (DCIS) that has been widely removed and for elderly women with stage I breast cancer whose cancers have been widely removed.

Am I a good candidate for a 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 within the breast, and the skill of the surgeon.  We may sometime recommend chemotherapy or anti-estrogen medications prior to surgery to shrink a cancer and make it more amenable to lumpectomy. 

How is complete removal of the cancer ensured?

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:

  • Preoperative MRI
  • Intraoperative Ultrasound
  • Bracketed Wire-Localization
  • Intraoperative Pathology Consultation
  • Intraoperative Specimen X-rays

 

View Surgical Margins

 

What other steps may be taken to improve breast appearance after lumpectomy?

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.  

For more information about breast cancer surgery, visit Dr. Holmes’s YouTube Channel here.

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