Lumpectomy or Mastectomy: Making the Decision That’s Best for You

Many are aware that breast cancer is the second common cancer in women after skin cancer. One in eight will be diagnosed, most after age 50. Fortunately, 3D mammograms are able to better detect breast cancer in dense breast tissue and often in its early stages. Once a breast cancer diagnosis is made, one decision women may face is whether to opt for a lumpectomy or mastectomy. It can be a difficult decision to make, but health history, stage of diagnosis and peace of mind are some of the factors that help women work with their provider to formulate a care plan that suits them best.

There are two main types of surgery to remove breast cancer:

Lumpectomy, also known as breast-conserving surgery or partial mastectomy, is a surgery that involves removing a tumor or tumors and a small margin of heathy tissue from the breast while leaving it intact. You may be a candidate for a lumpectomy if:

• The tumor is relatively small compared to your breast volume.
• You’ll likely have enough remaining tissue to reshape your breast once the tumor is removed.
• Your health and schedule will allow you to complete radiation therapy afterward to reduce the risk of cancer returning in the remaining breast tissue.

During a lumpectomy, lymph nodes are often removed from the armpit closest to the tumor to be tested for cancer cells. Most leave the hospital the same day and, while recovery times vary, many recover within a week.

Mastectomy is surgery that removes the entire breast, including all of the breast tissue and sometimes other nearby tissues. There are several different types of mastectomies. Some women may also have both breasts removed if they feel cancer might be likely in the other breast. Women who have mastectomy for early-stage cancers are less likely to need radiation. You may be a candidate if:

• You have a tumor larger than five centimeters or larger relative to your breast volume.
• A lumpectomy is unable to remove the cancer without a clear margin.
• You are unable to tolerate radiation.
• You have an inherited gene such as BRCA1 or BRCA2 that increases your risk of a second cancer developing.

Lymph nodes may be removed for testing just as they are during a lumpectomy. A mastectomy is a more extensive surgery, so full recovery may take several weeks. A mastectomy also generally reduces the risk of recurrence because more tissue is removed. If reconstruction is wanted, you can talk with your doctor to see whether it can be done at the time of mastectomy.

Whatever your choice, much support and information is available to help you make an informed decision you are comfortable with; both options offer similar survival rates. Catching cancer early through regular mammograms is key to helping you achieve the best possible outcome either way.

Christopher Garces, M.D., F.A.C.S., is a board-certified general surgeon specializing in breast surgery. He devotes his practice to the care of breast patients which includes cancer and non-cancer breast problems. Dr. Garces is specially trained in the latest surgical and non-surgical treatment for benign and malignant breast diseases. He also treats malignant melanoma. Learn more about Dr. Garces at www.mymichigan.org/garces.