Types of Lumpectomy Surgery

Lumpectomy is a type of breast-conserving surgery designed to remove cancerous or abnormal tissue from the breast while preserving as much of the natural breast as possible. It is often used to treat early-stage breast cancer or to remove suspicious lumps. Unlike mastectomy, which involves removal of the entire breast, a lumpectomy focuses on removing only the tumor and a margin of surrounding tissue.

Over time, surgical techniques have evolved, leading to several types of lumpectomy surgery, each suited to specific medical and cosmetic needs. Understanding these variations helps patients and their healthcare teams choose the most appropriate approach for their situation.

Types of Lumpectomy Surgery

1. Standard Lumpectomy :- A standard lumpectomy, also referred to as a wide local excision, is the most common form of lumpectomy surgery. In this procedure, the surgeon removes the tumor along with a rim of healthy tissue, known as the surgical margin, to ensure that all cancerous cells have been excised.This types of lumpectomy surgery is usually recommended when the tumor is relatively small in relation to the size of the breast, making it possible to remove the mass without significantly altering the shape or appearance of the breast.
   • Minimal cosmetic change
     
   • Typically performed under general anesthesia
     
   • Often followed by radiation therapy to reduce recurrence risk
2. Oncoplastic Lumpectomy :- Oncoplastic lumpectomy combines traditional tumor removal techniques with plastic surgery principles to maintain or improve the breast’s appearance after surgery. This approach is particularly beneficial for patients with larger tumors or those with smaller breasts, where tissue removal could cause significant cosmetic defects.The procedure may involve reshaping the remaining breast tissue or even performing surgery on the opposite breast to maintain symmetry. In some cases, flaps of tissue from other areas of the body are used to reconstruct the breast.
   • Preserves breast appearance
     
   • Can correct breast asymmetry
     
   • Requires coordination between surgical oncologists and plastic surgeons
3. Wire-Guided Lumpectomy :- Wire-guided lumpectomy is typically used when the tumor is not palpable (cannot be felt by hand), such as in the case of microcalcifications or small non-invasive cancers detected through mammograms or MRIs.Before surgery, a radiologist places a thin wire into the breast to mark the precise location of the abnormal tissue. During surgery, the surgeon uses this wire to guide the excision.
   • Ideal for non-palpable or small tumors
     
   • Involves preoperative imaging and localization
     
   • High precision in targeting abnormal tissue
4. Radio-Guided Occult Lesion Localization (ROLL) Lumpectomy :- The ROLL technique is another method used for non-palpable breast lesions. In this procedure, a small amount of radioactive substance is injected into the tumor site before surgery. A handheld gamma probe is then used by the surgeon to locate and remove the tumor during the operation.Compared to wire-guided lumpectomy, ROLL may offer greater comfort and fewer cosmetic issues since no wire protrudes from the breast prior to surgery.
   • Less invasive and more comfortable preoperative procedure
     
   • High accuracy with minimal tissue removal
     
   • Usually requires nuclear medicine support
5. Intraoperative Ultrasound-Guided Lumpectomy :- For tumors visible on ultrasound, surgeons may use intraoperative ultrasound to guide the lumpectomy in real time. This technique allows the surgeon to pinpoint the tumor’s exact location and margins during surgery, potentially increasing the chances of complete tumor removal in a single operation.This method reduces the need for additional surgeries due to positive margins (cancer cells remaining at the edges of the removed tissue).
   • Real-time imaging during surgery
     
   • Better precision and fewer repeat surgeries
     
   • No need for pre-surgical wire placement
6. Vacuum-Assisted Lumpectomy :- Vacuum-assisted lumpectomy is a minimally invasive alternative often used for benign lumps or small cancers. This procedure involves inserting a probe into the breast under local anesthesia. The probe uses suction to remove the lesion through a small incision.While not appropriate for all breast cancers, this method is highly effective for certain non-cancerous conditions such as fibroadenomas or papillomas.
   • Performed under local anesthesia
     
   • Minimal scarring and quick recovery
     
   • Limited use for malignant tumors
7. Re-Excision Lumpectomy :- Sometimes, after the initial lumpectomy, the pathology report reveals that cancer cells are still present at the edges of the removed tissue. In such cases, a re-excision lumpectomy is performed to remove additional tissue and achieve clear margins.This procedure is more common in patients with ductal carcinoma in situ (DCIS) or when tumors have irregular shapes or borders.
   • Necessary when margins are not clear
     
   • May be done shortly after the original surgery
     
   • Helps reduce the risk of cancer recurrence
8. Skin-Sparing Lumpectomy :- Skin-sparing lumpectomy is a specialized procedure used when surgeons want to preserve as much of the skin envelope as possible. This is especially useful if future reconstructive surgery is anticipated. While commonly associated with mastectomy, skin-sparing principles can be applied to lumpectomy as well.This approach may include precise incisions to limit skin disruption and help maintain a natural breast contour.
   • Preserves natural skin for reconstruction
     
   • May involve tissue rearrangement or flaps
     
   • Used in conjunction with plastic surgery techniques

Choosing the Right Type of Lumpectomy

The choice of lumpectomy type depends on several factors, including:

• Size and location of the tumor
• Breast size and shape
• Presence of multiple lesions
• Cosmetic concerns
• Imaging findings
• Patient preference and overall health
  

Your surgical team will usually include a breast surgeon, radiologist, and potentially a plastic surgeon to help determine the most appropriate procedure.

Conclusion

Lumpectomy offers a breast-conserving alternative for many patients diagnosed with early-stage breast cancer or benign breast lesions. The advancement of surgical methods has significantly improved both oncologic outcomes and cosmetic satisfaction. From traditional lumpectomy to innovative techniques like oncoplastic and ultrasound-guided surgeries, each option serves a distinct purpose in individualized patient care.

Understanding the different types of lumpectomy surgery empowers patients to engage actively in treatment planning and make informed choices about their health and body. As always, consultation with a qualified surgical team is essential to determine the most suitable path forward.