Contributor: Stephanie Valente, DO
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To treat breast cancer with surgery, you have two main options: mastectomy (complete removal of the breast) or lumpectomy (removal of only the part of the breast that has the cancer). How do you decide what is best for you?
Many factors affect this important choice. It’s important to review each option in detail with your surgeon. Here are some things to consider.
If you choose mastectomy
If you choose a mastectomy, there are options regarding whether or not to choose reconstruction. Some women choose to not have breast reconstruction, while others choose to have reconstruction that most often happens during the initial cancer surgery.
A plastic surgeon works with the breast surgeon. The breast surgeon performs either a skin-sparing or nipple-sparing mastectomy and then the plastic surgeon recreates a breast using a tissue expander (temporary implant), implant or a patient’s own tissue.
If you choose lumpectomy
For a lumpectomy, the surgeon removes the cancer mass with a normal rim of surrounding healthy tissue called a margin. A lumpectomy allows a woman to keep her breast. It’s also referred to as a partial mastectomy or breast conservation.
This option also would require radiation to the breast to prevent the cancer from returning. There are different options for radiation, which is usually given daily (i.e. each weekday for five to six weeks).
Some women qualify for a shortened course of radiation, which lasts three weeks, and other women qualify for a single dose of radiation given during surgery called intraoperative radiation. You can discuss these options with your surgeon in greater detail.
What option leads to the best outcomes?
When a woman hears that she has breast cancer, she may think that the most aggressive surgery leads to the best outcome. This is not the case. Studies show that mastectomy vs. a lumpectomy plus radation offer a woman similar survival.
The risk of a recurrence in the breast after a mastectomy is 5 percent, while the risk of a recurrence in the breast after a lumpectomy and radiation is 14 percent. The risk of getting breast cancer just for being a woman is 12 percent. The differences between recurrence rates are not statically significant – with the overall survival being the same.
Surviving breast cancer
So let’s talk about survival, because that is ultimately the most important question when it comes to breast cancer.
Survival from breast cancer depends on the stage of your breast cancer (the size of the cancer and whether or not it has spread to your lymph nodes or other areas).
A medical oncologist uses your cancer stage and the biology of your breast cancer (what type it is) to determine if you will need chemotherapy.
The recommendation for chemotherapy is based on the type and stage of your cancer, not the type of surgery you choose. Again, many times, patients think that if they pick the most aggressive surgery, that they will not need chemotherapy and that is not the case.
So what helps a patient decide one surgery over another?
Some women have a large cancer and a small breast, so a lumpectomy would remove too much tissue to leave a breast with a good cosmetic result. These women need a mastectomy.
Other women, for various reasons, cannot receive radiation, or choose not to have it. These women choose a mastectomy.
Women who present with a small breast cancer are great candidates for a lumpectomy.
Most women are actually candidates for both surgical options and have the opportunity to choose.