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Choosing Between Lumpectomy and Mastectomy

Posted Nov 07 2010 12:00am

Many women with early-stage breast cancers have the option of choosing between a breast-conserving surgery such as a lumpectomy or a mastectomy which removes the entire breast tissue.

The main advantage of a lumpectomy is that it allows a woman to keep most of her breast. A disadvantage is the usual need for radiation therapy most often for 5 to 6 weeks after surgery. A (very) small number of women having breast-conserving surgery may not need radiation, while a small percentage of women who undergo mastectomy will still need radiation therapy to the breast area.

When deciding between a lumpectomy and mastectomy, be sure to get all the facts. Often times women have an initial preference for mastectomy. This is a natural “gut reaction” to the diagnosis of cancer, as we would want to take everything out as quickly as possible. The fact of the matter, however, is that in most cases mastectomy does not give you any better chance of long-term survival or a better outcome from treatment than lumpectomy. Studies following thousands of women for more than 20 years show that when a lumpectomy can be done, doing a mastectomy instead does not provide any better chance of survival.

Most women and their doctors prefer lumpectomy and radiation therapy when it’s a reasonable option, but your choice will depend on a number of factors, such as:

  • How you feel about losing your breast
  • How you feel about getting radiation therapy (and the side effects that go along with it)
  • How far you would have to travel and how much time it would take to have radiation therapy
  • Whether you think you will want to have more surgery to reconstruct your breast after having a mastectomy
  • Your preference for mastectomy as a way to get rid of all your cancer as quickly as possible
  • Your fear of the cancer coming back

For some women, mastectomy may clearly be a better option. For example, lumpectomy or breast conservation therapy is usually not recommended for:

  • Women who have already had radiation therapy to the affected breast
  • Women with 2 or more areas of cancer in the same breast that are too far apart to be removed through 1 surgical incision, while keeping the appearance of the breast satisfactory
  • Women whose initial lumpectomy along with re-excision(s) has not completely removed the cancer
  • Women with certain serious connective tissue diseases such as scleroderma or lupus, which may make them especially sensitive to the side effects of radiation therapy
  • Pregnant women who would require radiation while still pregnant (risking harm to the fetus)
  • Women with large tumors (greater than 5 cm) that didn’t shrink very much with neoadjuvant chemotherapy
  • Women with inflammatory breast cancer
  • Women with a cancer that is large relative to her breast size

Other factors may need to be taken into account as well. For example, young women with breast cancer and a known genetic (BRCA) mutation are at very high risk for a second cancer. These women often consider having the other breast removed to reduce this risk, and so may choose to have the cancer treated with a mastectomy, as well. A double mastectomy may be done to both treat the cancer and reduce the risk of a second breast cancer.

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