Lumpectomy vs. Mastectomy
Decades ago, a diagnosis of breast cancer was devastating and almost always meant that a woman would undergo a mastectomy—removal of the entire breast. Today, with regular screening mammograms, breast cancers are often caught in earlier stages, allowing women the choice between a lumpectomy (removal of part of the breast) and a mastectomy. The decision to offer a lumpectomy is largely driven by the size of the tumor in relation to the size of the breast. If I think the cosmetic result after a lumpectomy would be acceptable, I offer it to my patients. So, how do patients choose between the two surgeries?
The most important fact about these two options is that survival 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 in recurrence. The rate of breast cancer recurring in the same breast after a mastectomy is about 1%; and about 10-15% after lumpectomy with radiation. Importantly, the outcomes in either case are great, and most women in both categories will never have to deal with breast cancer again. Women who choose lumpectomy have a slightly higher chance of needing treatment again, but even with mastectomy, the recurrence rate is not zero.
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After understanding that, the preference of the patient is the major consideration. A lot of women make decisions based on fear, emotions, or misinformation. But as GI Joe always said, “Knowing is half the battle.” So let’s get educated.
What you need to know
Neither surgery has any bearing on whether or not you’ll need chemotherapy
Having more extensive surgery does not mean you can avoid chemotherapy. (The need for chemotherapy is determined by how much and what type of cancer is present, as well as the patient’s health, but NOT by what type of surgery is chosen.) However, other factors may weigh in the choice. For example, women who cannot have radiation therapy, due to previous chest radiation treatment or a connective tissue disorder, may need mastectomy. A lumpectomy may be safer for women with heart problems or diabetes because they won’t be on the operating room table as long, or may not 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. Women should ask themselves “What is my main concern?” I advise patients to look at photos to learn what lumpectomies and mastectomies (with or without reconstruction) look like, so they can understand the reality. Talking to other women who have gone through this is also helpful.
Ultimately, there is no wrong decision, but I urge patients to consider all the factors, and to think about the long-term. I want my patients to understand the facts, consider what’s truly best for them, and feel confident about their decision.