How Surgeons Plan a Lumpectomy: From Imaging to the Operating Room

When you hear the word “lumpectomy,” it’s easy to focus on the day of surgery. What many people don’t realize is how much thoughtful planning happens well before you ever change into a gown. Understanding how your care team prepares can make the process feel clearer, more organized, and easier to navigate.

Step 1: Seeing the Full Picture With Imaging

The first step in planning a lumpectomy is getting to know your breast and your tumor as clearly as possible. Depending on your individual situation, this may include:

• A mammogram, which shows the overall breast tissue and can highlight calcifications or areas that look different
• Ultrasound is often used to take a closer look at the tumor and surrounding tissue in real time
• MRI, when needed, to provide additional detail in certain cases, such as dense breast tissue or more complex findings

Each type of imaging adds another layer of information. Together, they help your surgeon understand the size and shape of the tumor, where it sits within the breast, and how close it may be to the skin or chest wall.

Step 2: Locating the Exact Spot

If a tumor is easy to feel, your surgeon may be able to locate it during surgery without extra guidance. If it’s smaller, deeper, or only visible on imaging, your team may use localization tools to mark the area ahead of time.
These may include:

• A thin wire placed by a radiologist on the day of surgery
• A small seed or marker is placed days in advance and detected in the operating room
• Magnetic markers or other guidance technologies

These tools act like a roadmap, helping your surgeon reach the tumor precisely while limiting how much healthy tissue is disturbed.

Step 3: Planning for Both Cancer Control and Appearance

Today’s lumpectomy planning focuses on more than removing the cancer—it also considers how your breast will look and feel afterward. Many surgeons use oncoplastic techniques, which combine cancer surgery with thoughtful reshaping of the breast.

During planning, your surgeon may think about:

• Where the incision can be placed for both access and appearance
• How tissue can be moved or reshaped to support a natural contour
• Whether a small adjustment to the other breast could help with balance, either at the same time or later

You can always ask to see drawings or examples to better understand what’s being planned.

Step 4: What Happens in the Operating Room

On the day of surgery, all of this preparation comes together. During the lumpectomy, your surgeon will:

• Use imaging and localization markers to remove the tumor along with a rim of healthy tissue (called a margin)
• Carefully orient the tissue so the pathologist knows which edge corresponds to which area of your breast
• Often, image the removed tissue to confirm the tumor and any markers are included

Behind the scenes, your surgeon and the pathology team work closely together. How tissue is removed, labeled, and examined helps guide margin assessment and next steps in care.

Step 5: Where LumiSystem™ May Fit

Some centers now incorporate tools like LumiSystem™ into the lumpectomy process to provide additional information during surgery.

Here’s how it may be used:

• Before surgery, you receive LUMISIGHT™(pegulicianine), an optical imaging agent designed to respond to certain signals associated with cancer cells and nearby immune cells
• After the tumor is removed, the surgeon uses the LumiSystem camera to gently scan the lumpectomy cavity
• Areas that give a signal may prompt a closer look and, in some cases, removal of additional tissue during the same operation

LumiSystem does not replace standard lumpectomy techniques or pathology. It is an added tool that some surgeons use to support careful decision-making in the operating room.

Safety Notes to Keep in Mind

Like all medical tools, LUMISIGHT™ and LumiSystem™ come with both benefits and risks. The most common side effects with LUMISIGHT(TM) (pegulicianine) are hypersensitivity and an abnormal color in urine. LUMISIGHT may cause serious hypersensitivity reactions, including anaphylaxis. Please see the LUMISIGHT Prescribing Information, including Boxed Warning, and Lumicell DVS Instructions for Use. For complete product information, visit www.LumiSystem.com.

It’s also helpful to remember:

• A signal does not always indicate cancer; noncancerous tissue can sometimes respond
• The absence of a signal does not guarantee that every cancer cell has been removed

Final treatment decisions are always guided by the full surgical plan, imaging, and pathology results.

Questions You Might Ask About Planning

If you’re preparing for surgery, these questions can help guide the conversation:

• What imaging did you use to plan my lumpectomy, and what did it show?
• Will localization tools like a wire, seed, or magnetic marker be used, and what should I expect?
• How are you thinking about both cancer control and how my breast will look afterward?
• Will any additional tools, such as LumiSystem, be used during my surgery?

To see how this planning fits into the bigger picture, you can explore the main Lumpectomy Guide on Learn Look Locate, which brings together information on surgery, margins, recovery, and newer technologies in one place.

FAQs: Planning a Lumpectomy

Q.1 Why is so much planning needed before a lumpectomy?
A: Careful planning helps surgeons remove the cancer accurately while preserving as much healthy breast tissue as possible.

Q2. Will everyone need localization before surgery?
A: No. Localization is used when a tumor isn’t easily felt and needs imaging guidance to pinpoint its location.

Q3. What are oncoplastic techniques?
A: These techniques combine cancer removal with reshaping of the breast to support both treatment goals and appearance.

Q4. Does imaging during surgery replace pathology?
A: No. Imaging tools may provide additional information during surgery, but final decisions rely on pathology results.

Q5. Are tools like LumiSystem used for everyone?
A: No. Availability and use depend on the hospital and whether the surgeon believes it may be helpful in a specific case.

Q6. What if I still have questions after reading this?
A: That’s expected. This information is meant to help you prepare for conversations with your care team, not replace them.

Important Safety Information

What is LUMISIGHT (pegulicianine) and Lumicell DVS?

• LUMISIGHT (pegulicianine) is an optical imaging agent and Lumicell DVS is a fluorescence imaging device. LUMISIGHT and Lumicell DVS, in combination, are used in adults with breast cancer to help detect any remaining cancerous tissue at the surgical site following removal of the primary specimen during a lumpectomy procedure.

What is the most important information to know about LUMISIGHT?

• Hypersensitivity Reactions: LUMISIGHT may cause serious hypersensitivity reactions, including anaphylaxis. Anaphylaxis has occurred in 4/726 (0.6%) of patients in clinical studies. Tell your doctor if you have any history of hypersensitivity reactions to pegulicianine or to contrast media or products containing polyethylene glycol (PEG). Your healthcare provider should have emergency resuscitation drugs, equipment, and trained personnel available during the use of LUMISIGHT. Healthcare providers should monitor all patients for hypersensitivity reactions and if one is suspected, immediately discontinue the injection and initiate appropriate therapy.
• The most common side effects (≥1%) include hypersensitivity and an abnormal color in urine.

What additional important information should I know about LUMISIGHT and Lumicell DVS?

• Adjunctive Use: Lumicell DVS is for use as part of the lumpectomy procedure and is not a replacement for the standard of care lumpectomy procedure and pathology.
• Risk of Misdiagnosis: The absence of a signal in surgery does not rule out cancer. Additionally, a positive signal may be seen in noncancerous tissue.
• Interference from Dyes Used for Sentinel Lymph Node Mapping: Your healthcare provider should avoid use of dyes before imaging the lumpectomy cavity in patients who have received LUMISIGHT.
• Other Risks: Using the Lumicell DVS handheld probe may cause tissue damage or infection.

You are encouraged to report negative side effects of prescription drugs to the FDA. Visit MedWatch or call 1-800-FDA-1088. Please see the LUMISIGHT Prescribing Information, including Boxed Warning, and Lumicell DVS Instructions for Use. For complete product information www.LumiSystem.com.