Lumpectomy, also known as breast-conserving surgery, is a localized excision procedure primarily aimed at removing tumor tissue within the breast while preserving as much normal breast structure as possible. This surgery is suitable for patients with smaller tumors that have not invaded surrounding tissues and can be combined with radiation therapy or chemotherapy to enhance treatment efficacy.
This approach integrates precise surgical technology with cancer control strategies, effectively removing diseased tissue while maintaining breast appearance, meeting patients' dual needs for quality of life and physical and mental health. Postoperative pathological examination is usually required to confirm clear margins and reduce the risk of recurrence.
Lumpectomy is divided into "local excision" and "wide excision." The former targets small tumors for precise removal, while the latter involves expanding the excision area to ensure complete removal of the lesion. The surgical mechanism involves making an incision to remove the tumor and a small amount of surrounding normal tissue, then suturing to repair the wound, preserving most of the breast tissue.
The success of the surgery depends on the pathologist confirming negative margins, ensuring no residual tumor cells remain. This process may include intraoperative frozen section analysis to adjust the excision range in real-time, improving precision.
Primarily suitable for patients with stage I or stage II breast cancer, with tumors usually less than 5 cm in diameter and no axillary lymph node metastasis. It is also appropriate for patients with a single lesion who strongly wish to preserve their breast.
Contraindications include tumors occupying more than 50% of the breast, multiple lesions, or patients unable to undergo postoperative radiotherapy due to other health factors. Imaging examinations such as mammography or ultrasound are used to assess eligibility.
The surgery is typically performed under general anesthesia. The surgeon designs an incision based on the tumor location to remove the tumor along with 0.5-2 cm of normal tissue around it. A drainage tube is usually placed for 2-3 days postoperatively to drain fluids, with regular review of pathological reports.
The treatment process may include: 1. Preoperative imaging localization; 2. Surgical excision; 3. Margin confirmation; 4. Postoperative radiotherapy planning. The entire process requires multidisciplinary teamwork, including oncologists and radiation oncologists.
This therapy is especially suitable for cases where the tumor location is concealed or the patient has a strong aesthetic desire, allowing daily activities to remain unaffected.
Short-term risks include postoperative bleeding, infection, and subcutaneous seroma, with an incidence of about 5-10%. Long-term effects may include radiation dermatitis or tissue fibrosis, affecting about 20-30% of patients, with mild scars or changes in texture.
Serious complications include: 1. Positive margins requiring reoperation; 2. Radiation-induced cardiopulmonary complications; 3. Discovery of occult lesions necessitating upgraded treatment plans.
Patients should inform their doctor before surgery if they have had previous breast surgery or bleeding tendencies. Patients with diabetes or blood disorders need to adjust anticoagulant medication timing, and postoperative adherence to radiotherapy schedules is crucial.
Contraindications include: 1. Tumors invading the pectoral muscle or skin; 2. Patients unable to undergo postoperative radiotherapy; 3. Presence of systemic metastases.
Often combined with radiotherapy, starting within 3-6 weeks after surgery to reduce local recurrence. If combined with chemotherapy, it should be confirmed whether chemotherapy has sufficiently shrunk the tumor to avoid affecting surgical precision.
Patients receiving hormone therapy should be aware that postoperative radiotherapy may increase skin irritation, requiring adjustment of medication timing. Immunotherapy generally does not affect surgical procedures but requires evaluation of cumulative systemic side effects.
Multiple international studies show that lumpectomy combined with radiotherapy achieves a 10-year local control rate of 85-90%, comparable to total mastectomy. Data from the National Cancer Institute indicate that early breast cancer patients undergoing this treatment have better overall survival and aesthetic satisfaction than those undergoing traditional surgery.
The 2018 meta-analysis in The Lancet Oncology reported that the 5-year survival rate difference between breast-conserving surgery and mastectomy is less than 2%, confirming its efficacy and safety. However, high-risk subgroups (such as HER2-positive breast cancer) may require intensified postoperative therapy.
The main alternative is "total mastectomy," suitable for cases with widespread tumor distribution or patient preference for simplified treatment. Observation with close monitoring is another option.
Emerging therapies such as "breast-conserving mastectomy" or "minimally invasive ablation" are still in clinical trials and should be discussed with a physician to weigh risks and benefits. When choosing, factors such as tumor characteristics, patient preferences, and long-term follow-up feasibility should be considered.
Patients should undergo comprehensive cancer staging examinations, including ultrasound, mammography, or MRI, to confirm the tumor extent. The surgeon will assess the tumor size relative to breast size to ensure the shape remains acceptable after removal. Additionally, cardiopulmonary function tests may be required, and patients should inform their doctor of any medications they are taking to avoid anesthesia risks.
How can postoperative swelling and pain be alleviated?In the early postoperative period, pain relief medications should be used as prescribed, and cold compresses (wrapped in a towel to avoid direct skin contact) can be applied to reduce swelling. Avoid lifting heavy objects or overusing the affected arm. Wearing a wireless bra can reduce pressure. If pain persists beyond 3 days or is accompanied by fever, medical attention should be sought immediately.
When can daily activities and exercise be resumed after breast-conserving surgery?Light activities such as walking can usually start within a week, but strenuous exercise should be avoided for at least 4 weeks to prevent wound disruption. The exact recovery time varies depending on individual healing, and the medical team will gradually advise increasing activity intensity. Heavy lifting or high-intensity training should wait for more than 6 weeks and should be discussed with healthcare providers.
What factors may affect the success rate of breast-conserving surgery?Tumor size, location, and lymph node involvement are key factors. If the tumor occupies a large portion of the breast, preoperative chemotherapy may be needed to shrink it. Patient adherence to postoperative radiotherapy is also crucial; incomplete radiotherapy can increase recurrence rates by 10-20%. Regular follow-up and early detection of abnormal changes can improve treatment outcomes.
What long-term follow-up examinations are required after surgery?Doctors typically schedule physical examinations every 3-6 months, along with annual mammography. If lymph node metastasis was present before surgery, periodic blood marker tests may be necessary. Follow-up should continue for at least 5 years; if no recurrence occurs within this period, subsequent examinations can be spaced every 1-2 years, with ongoing observation of breast shape and any abnormal symptoms.
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