Mastectomy vs. Lumpectomy

Today, many women with breast cancer are given the opportunity to choose between total removal of a breast (mastectomy) and breast-conserving surgery (lumpectomy) followed by radiation.

For women with only one site of cancer in their breast, and a tumor under four centimeters that was removed with clear margins (no cancer cells in the tissue surrounding the tumor), lumpectomy followed by radiation is likely to be equally as effective as mastectomy.

Although most women who have a choice prefer the less invasive lumpectomy, what you choose will depend on many factors, including:

• whether or not radiation therapy is as good an option for you relative to mastectomy

• whether you are interested in reconstructive surgery

• how important keeping your breast is to you

• how much you think that removing the entire breast would help YOU worry less about the possibility of the breast cancer coming back.

Where you live may also play a role in your decision. Research has shown that women who live in the United States are more likely to have mastectomy than women in other countries. We don't know why this is, but it probably has something to do with the attitudes of the women and their doctors. Other research has shown that your choice of surgeon influences which treatment options you're offered. If you feel strongly about one option over the other, ask your surgeon how mastectomies and lumpectomies he or she does, and why. Seek a second opinion to get a more complete and balanced understanding of your options.

The main advantage of lumpectomy is that it can preserve much of the appearance and sensation of your breast. It is a less invasive surgery, so your recovery time is shorter and easier than with mastectomy.

Lumpectomy followed by radiation has several drawbacks:

• After surgery, you are likely to have five to seven weeks of radiation therapy, five days per week, to make sure the cancer is gone.

• You are at a somewhat higher risk of developing a local recurrence of the cancer than are women who undergo mastectomy. However, recurrence can be treated successfully with mastectomy.

• Your breast cannot safely tolerate additional radiation if cancer occurs in the same breast after lumpectomy. This is true for either a recurrence of the same cancer, or for a new cancer. If you have a second cancer in the same breast, your doctor will usually recommend that your breast be removed.

For some women, removing the entire breast provides greater peace of mind ("just get the whole thing out of there!"). Radiation therapy may still be needed, depending on the results of the pathology.

Mastectomy has three main drawbacks:

1. The surgery is longer and more extensive, with more post-surgery side effects and a longer recuperation time.

2. The surgery means a permanent loss of your breast.

3. If, like most women, you pursue reconstruction after mastectomy, you are likely to face additional surgeries in a multi-step cosmetic procedure.

Making your own decision

Your breasts may be such an important part of your identity—your sense of who you are—that you'll go to great lengths to preserve them. That's a completely acceptable approach to take, no matter what your age or figure—AS LONG AS it doesn't endanger your overall health and chances for a full recovery.