What you can expect

Locating the area to be removed

Your lumpectomy procedure begins with locating the area of your breast that contains the abnormality (localization procedure). To do this, a doctor who uses imaging tests to diagnose and treat diseases (radiologist) uses a mammogram or ultrasound to locate the tumor and insert a thin wire, needle or small radioactive seed. Your surgeon uses this as a guide to find the precise area that needs to be removed during surgery.

If you have a lump or mass in your breast that can be easily felt through the skin, the localization procedure may not be necessary because the surgeon can more easily find the abnormal area to be removed.

Preparing for lymph node removal

Your surgeon may recommend removing lymph nodes near your armpit to see whether cancer has spread beyond the breast. Surgery to remove a few lymph nodes (sentinel node biopsy) is often recommended for early-stage breast cancer. If cancer was found in a lymph node before surgery or if there's a concern that the cancer has spread, your surgeon may recommend removing a number of lymph nodes near your armpit (axillary lymph node dissection).

Lymph node removal procedures include:

• Sentinel node biopsy. During this procedure your surgeon removes only the first one or two nodes into which the cancer drains (sentinel nodes). These are then tested for cancer. Your doctor may recommend this procedure if there are no concerns about enlarged lymph nodes prior to your surgery.

  Before your surgery, a radioactive substance or blue dye or both is injected into the area around the cancer or the skin above the cancer. The dye travels to the sentinel node or nodes, allowing your surgeon to identify and remove them.

  If no cancer is present in the lymph nodes, no further lymph nodes need to be removed. If cancer is present, the surgeon will discuss options, such as receiving radiation to the armpit. If this is what you decide to do, you will not need to have more lymph nodes in the armpit removed.

• Axillary lymph node dissection. During this procedure, the surgeon removes a number of lymph nodes from your armpit. Your surgeon may recommend this procedure if a lymph node biopsy done before surgery shows signs of cancer.

During the procedure

A lumpectomy is usually performed using general anesthesia, which will put you into a sleep-like state during the procedure.

Your surgeon will make an incision over the tumor or over the area that contains the wire or seed, remove the tumor and some surrounding tissue, and send it to the lab for analysis. He or she will do the same for the sentinel lymph node or nodes if you're having a sentinel node biopsy or the axillary lymph nodes if you're having an axillary lymph node dissection.

The surgeon will then close the incisions with attention to preserving the appearance of your breast, using stitches (sutures) that will either dissolve on their own or be removed later by your doctor. Your surgeon may also place thin adhesive strips or use glue on the incision to keep it closed until it heals.

After the procedure

After your surgery, you'll be taken to a recovery room. During this time, your blood pressure, pulse and breathing will be monitored.

If you've had outpatient surgery — usually lumpectomy and sentinel node biopsy — you'll be released when your condition is stable

If you've had axillary lymph node dissection, you may need to stay in the hospital for a day or two if you're experiencing pain or bleeding.

Expect to have:

• A dressing (bandage) over the surgery site
• Some pain, numbness and a pinching sensation in your underarm area
• Written instructions about post-surgical care, including caring for the incision and dressing and recognizing signs of infection
• Prescriptions for pain medication and possibly an antibiotic
• Some restrictions of activity
• A follow-up appointment with your doctor, usually seven to 14 days after surgery