Removing the tumour with a margin of healthy tissue, while preserving most of the breast. For the majority of small to moderate-sized breast cancers, breast-conserving surgery combined with radiotherapy offers survival equivalent to mastectomy.
Lumpectomy is the gold standard surgery for small to medium-sized breast cancer. It preserves most of the breast, with survival outcomes equivalent to mastectomy.
Lumpectomy removes only the tumour and a margin of healthy tissue around it (1 to 5 mm), preserving most of the breast. This margin is what guarantees the oncological quality of the procedure — its absence exposes the patient to a risk of local recurrence.
The procedure is performed under general anesthesia, lasts 30 minutes to 1h15 depending on tumour size and whether oncoplastic remodeling is performed, and is done as day surgery in the vast majority of cases — you arrive in the morning and go home the same evening.
In most cases, a single simple incision is sufficient — either directly over the tumour, or peri-areolar (around the areola) if the tumour is close to the nipple. The aesthetic result is generally very satisfactory when the volume of tissue removed remains modest relative to breast size.
When remodeling is needed — oncoplastic surgery. When the volume of tissue removed is significant relative to breast size, the remaining glandular tissue can be reshaped at the end of the procedure to restore a harmonious breast contour — this is called oncoplastic surgery. The technique (Round Block, inverted-T, radial mammoplasty, perforator flap, Batwing) is chosen on a case-by-case basis.
Adjuvant radiotherapy is systematic after lumpectomy, except in rare cases. It usually starts 2 to 3 months after surgery, over 1, 3 or 5 weeks depending on the protocol. It is what guarantees the survival equivalence with mastectomy — it is an inseparable part of breast-conserving treatment. This equivalence has been demonstrated by historical randomized trials with 20-year follow-up (Milan 1973, NSABP B-06 1976) and confirmed by the EBCTCG meta-analysis pooling the major comparative studies.
If the final pathology report shows insufficient margins — 10 to 15% of cases — a re-excision is organised to complete the resection. This re-excision is generally simpler: either a wider lumpectomy or, more rarely, a mastectomy depending on residual disease extent.
Lumpectomy is preferred whenever breast-conserving treatment can offer good oncological control with a satisfactory aesthetic result.
Adjusted to breast size. A 2 cm tumour in a large breast leaves more margin than a 2 cm tumour in a small breast — the ratio matters more than the absolute size.
Complete excision must be feasible without major aesthetic sequelae. Central or retro-areolar tumours: discussed case by case.
Radiotherapy is inseparable from lumpectomy. Prior chest wall radiotherapy is a formal contraindication.
Tumour histology (invasive lobular, multifocal) influences how predictable the margins will be.
In these situations, a mastectomy is indicated:
Review of imaging and biopsy results, clinical examination, presentation of the available surgical techniques with anatomical models, and shared decision on the surgical plan. Time for reflection is always preserved.
The treatment plan is validated at a multidisciplinary tumour board (medical oncologist, radiation oncologist, pathologist, surgeon). Anesthesia consultation at least 48 hours before surgery.
For non-palpable lesions: preoperative radiological localization, with timing depending on the marker — wire (harpoon) localization (the morning of surgery or the day before), Magseed or Sirius clip (up to several weeks before, no time constraint). Sentinel lymph node tracer injection on the day of surgery. Standing surgical marking by the surgeon if oncoplastic remodeling is planned. Operating theatre.
General anesthesia. Lumpectomy with clear margins (1 to 5 mm), intraoperative margin assessment when feasible, and sentinel lymph node biopsy if invasive cancer. If oncoplastic remodeling is associated: glandular reshaping ± contralateral symmetrization. Duration 30 min to 1h15. Compression dressing. Clinique Hartmann or American Hospital of Paris.
Wound check. Review of the final pathology report (histological type, grade, margins, lymph nodes). Presentation of the adjuvant treatment plan validated at the MDT: radiotherapy, chemotherapy, hormone therapy depending on tumour profile.
In the vast majority of cases, recovery is straightforward and only mildly painful. A moderate tension-like discomfort, relieved by simple analgesics (paracetamol ± anti-inflammatories), may persist for a few days. A compression dressing shaped like a sports bra is applied and kept in place for 24 to 48 hours.
Sutures are generally absorbable — no removal needed. A nurse phones the patient the day after surgery to check for any complications. A support bra is recommended for 1 month.
Bruising is common and resolves within a few weeks. If blue dye was used for sentinel lymph node mapping, the skin may remain colored for several months — this is harmless.
Bathing and sports activities are not allowed for 1 month. All everyday activities are permitted. Adjuvant radiotherapy usually starts 2 to 3 months after surgery, over 1, 3 or 5 weeks depending on the protocol.
Lumpectomy is a well-standardized surgery, with rare complications. It remains a surgical procedure that carries a low but real risk. The main complications are listed below:
30 minutes to 1h15 depending on tumour size and whether oncoplastic remodeling is performed. Always under general anesthesia. Add 30 to 45 minutes if a sentinel lymph node biopsy or axillary dissection is associated.
Yes, in most cases. Simple lumpectomy is almost always performed as day surgery — same-day discharge. Only complex oncoplastic lumpectomies (inverted-T with symmetrization, perforator flap) may require a 1 to 2 night hospital stay.
Yes, systematically. Whenever breast-conserving surgery is performed, adjuvant radiotherapy follows. It usually starts 2 to 3 months after surgery, over 1, 3 or 5 weeks depending on the protocol. This radiotherapy is what guarantees local control and provides survival equivalent to mastectomy.
In most cases, a simple incision is sufficient — either directly over the tumour or peri-areolar (around the areola). The aesthetic result is generally very satisfactory when the volume of tissue removed remains modest relative to breast size. If oncoplastic remodeling is associated, the scar pattern depends on the technique chosen (Round Block, inverted-T, radial mammoplasty, perforator flap, Batwing).
10 to 15% of patients require re-excision if the final pathology report (available at day 15) shows insufficient margins. This re-excision is generally simpler — either a wider lumpectomy or, more rarely, a mastectomy depending on residual disease extent.
The historical randomized trials — Milan 1973 (Veronesi et al.) and NSABP B-06 1976 (Fisher et al.) — showed no long-term survival difference (20-year follow-up) between lumpectomy followed by radiotherapy and mastectomy. The EBCTCG meta-analysis (Early Breast Cancer Trialists' Collaborative Group) confirms this equivalence. The choice therefore depends on tumour characteristics (size, multifocality, achievable margins), anatomy (tumour-to-breast ratio, location) and personal preferences (radiotherapy contraindications). Lumpectomy is preferred whenever feasible. To go further: how to choose between lumpectomy and mastectomy.
Yes, and it's actually common. Preoperative (neoadjuvant) chemotherapy can shrink the tumour and make breast-conserving surgery feasible when it was not initially. Lumpectomy is then discussed based on treatment response and residual tumour size.
Breastfeeding remains possible after a lumpectomy, particularly if the surgery was limited. It may be reduced or impossible on the operated side depending on the extent of the procedure. Subsequent radiotherapy significantly reduces lactation capacity on the irradiated side. Discuss this with your surgeon if you have pregnancy plans.
Two possible situations, two adapted approaches. Choose the one that best matches your journey.
A second opinion at the practice to discuss together the choice between lumpectomy and mastectomy, oncoplastic indications, sentinel lymph node biopsy, and adjuvant radiotherapy.
Request a second opinion →Unsure or prefer talking? Request a callback from the secretary — Coralie will guide you to the right slot.
