Choosing the breast surgery that's best for you
Years ago, breast cancer surgery usually meant mastectomy, the removal of the entire breast. But today, advancements in treatment and early detection mean that many women can consider other options, such as lumpectomy, surgery to remove only the portion of the breast containing the tumor.
How do I choose between the two surgeries?
“That depends on a number of factors. Due to the size of the tumor compared to the size of the patient’s breast, some people must have a mastectomy. That’s not a choice,” says Jessica Young, MD, a surgical oncologist who specializes in breast cancer at Roswell Park Comprehensive Cancer Center.
Generally, people who may need a mastectomy are those with inflammatory breast cancer, very large or widespread tumors, multiple tumors, or tumors that are located close to the chest wall or the skin. Since lumpectomy often requires radiation therapy, people who cannot have radiation therapy due to previous chest radiation treatment or a connective tissue disorder may need a mastectomy.
“For people who have a choice, the studies show a lumpectomy being the better choice,” Dr. Young advises.
The most important fact when considering the two options is that the survival rate is the same. In large trials where women underwent either a lumpectomy with radiation or a mastectomy, there was no difference in survival – but there was a slight difference in recurrence, breast cancer coming back in the breast area itself.
The difference in recurrence rate between mastectomy and lumpectomy is now much lower than decades ago, says Dr. Young: “With a mastectomy recurrence is at about 2%, and with a lumpectomy and then subsequent radiation, it’s somewhere about 6 to 8% nationally. Contemporary studies say that it’s possibly even less than that, about 4 or 5%.”
Will I still need chemotherapy with a lumpectomy?
In either case, having more extensive surgery does not necessarily mean you will be able to avoid chemotherapy. The need for chemotherapy is determined by what type of cancer is present, how advanced it is and your overall health. It is not determined by what type of surgery you choose.
However, other factors may weigh in on how you, with your doctor, choose to undergo a mastectomy or lumpectomy. For example, if you have a genetic mutation like BRCA1 or BRCA2, or a strong family history of breast cancer, this may increase your chances for the cancer to return and should be considered in your decision.
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A lumpectomy may be a better choice for women with heart problems or diabetes because they may not be in surgery as long as you would be with a mastectomy or may not be able to heal a large incision well. Some choose mastectomy because they fear recurrence, or don’t want the anxiety of continued surveillance screenings. Others choose lumpectomy because they are worried about appearance or pain.
“Smaller surgery is less painful and less disfiguring,” says Dr. Young. “You retain the sensation of your skin. Most of the time you keep your nipple, and you can wear the same clothes you have been wearing. You’re not going to have to go through reconstructive surgery, and you feel generally better.”
A lot of women who have mastectomies, even with reconstruction, will notice a difference in the way they relate to others in their lives. For example, some may not want to be intimate with their partner or others won’t like wearing bathing suits, she adds: “Quality of life studies have shown that lumpectomy is better.”
What you need to know
Lumpectomy
Pros | Cons |
|---|---|
Shorter surgery | Usually requires radiation |
Less painful | Potential for another operation to achieve clear margins |
Better cosmetically | May need a mastectomy if cancer recurs |
Preserves nipple, chest wall sensation and sexual function | - |
Mastectomy
Pros | Cons |
|---|---|
Lower recurrence rate | Longer surgery and recovery |
Unlikely to need another operation | More painful |
Less likely to require radiation therapy | Cosmetically deforming (even with reconstruction, new breast will never look or feel completely like the original breast) |
- | May have higher chance of lymphedema |
Ultimately, there is no wrong decision. If you have the option of choosing a lumpectomy and mastectomy for breast surgery, ask yourself “What is my main concern?” To better understand the realities, research images of lumpectomies and mastectomies and talk to other women who have gone through the experience.
Why Roswell Park for breast cancer care
Roswell Park is focused on finding the best therapies and delivering the best patient care for all forms of cancer.
“I’m trained specifically in treating breast cancer. All my colleagues, including medical oncology, radiation oncology, pathology and radiologists, have special training and specialize in breast cancer.” Dr. Young says.
“I think that’s incredibly special and different from other places. In terms of the overall care, that’s what you’re getting, people who are focused solely on breast cancer.”
