So your recent diagnosis of breast cancer has left you confused. And, for good reason. No one expects to be diagnosed with breast cancer. After your diagnosis, it will seem like there are so many decisions to be made, with so little time. Most of them may not even make sense to you. As physicians, its our job to help provide some clarity when it comes to breast cancer treatment. Depending on how advanced your breast cancer is (what we in the medical field call stage) you will be faced with the option of either removing all of your breast (mastectomy) or conserving as much of your breast tissue as possible (lumpectomy). So how do you choose?
Breast Cancer Surgery
When surgeons mention breast-conserving surgery, what we are talking about is a Lumpectomy. Lumpectomy is the removal of your breast tumor (the “lump”) and some of the normal tissue around it. A Lumpectomy may also be called a Partial Mastectomy. The main advantage of a lumpectomy is that it allows you to keep most of your breast. A disadvantage is that in most cases you will need radiation therapy after a lumpectomy. In contrast, if you have a mastectomy there is only a small possibility that you will need radiation therapy to the breast area.
A Mastectomy involves removing all of your breast tissue. You will be left without a breast on the side of your surgery. The main advantage of a mastectomy is that by removing all of the breast tissue, there is less of a chance of tumor being left behind in other areas of your breast. As mentioned before, there is also less of a likelihood that you will need radiation therapy after a mastectomy.
How to decide between a Lumpectomy and Mastectomy
You need to be sure you have all the facts before you decide between a lumpectomy and mastectomy as treatment of your breast cancer. Your initial preference may be to lean towards a mastectomy. After all, it would give you more peace of mind to just get rid of the entire breast and have it over with. This “gut reaction” to your breast cancer diagnosis is perfectly normal, but please don’t act on it before having all the information at hand. The fact is that whether you get a lumpectomy or a mastectomy there will be no difference in your long-term survival. In other words, lumpectomy and mastectomy are equally effective in treating your breast cancer. There have been countless research studies which support this.
On average, most women and their doctors prefer lumpectomy and radiation therapy provided it can be done safely. Ultimately, it’s your choice. Some things to keep in mind when deciding between a lumpectomy or mastectomy:
- 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
In some cases, mastectomy is clearly 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 preoperative 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, if you are young, have a strong family history of breast cancer, or have a known genetic (BRCA) mutation then you are at very high risk for a second cancer. Not only would you be better off with a mastectomy in these situations, but you may also want to consider having the other breast removed to reduce your risk. A double mastectomy may be done to both treat the cancer and reduce the risk of a second breast cancer.
Dr. Michael Zadeh is an experienced breast cancer surgeon. If you have more questions regarding breast cancer surgery and treatment, feel free to contact our Encino office and schedule a consultation with Dr. Zadeh