Breast cancer: which surgery is right for you?

Some women want a lumpectomy to keep as much breast tissue as possible, while some want a mastectomy to reduce the risk of recurrence. Both surgeries have pros and cons.

No woman wants to hear these dreaded words coming from her doctor's mouth: you have breast cancer. Unfortunately, one in eight women will get a diagnosis of breast cancer in her lifetime, according to PubMed Health. If you have caught it early enough, chemotherapy and radiation might just be enough to make you a survivor. If the cancer is a bit more progressed, your doctor might advocate a combination of surgery and chemotherapy/radiation. Two broad categories of surgery exist to treat breast cancer: lumpectomy and mastectomy. Each has definite pros and cons.

Just a little bit: opting for a lumpectomy

A lumpectomy removes the cancerous lump from the breast plus a margin of normal tissue around it to make sure all the cancer is removed with the lump, according to the American Cancer Society. When all the cancer is removed, it is said to have clear margins. When cancer cells are found in this margin, the tumor had positive margins and some cancer cells might remain in the tissue. Radiation therapy usually follows a lumpectomy to make sure that all cancer cells are removed. During this procedure, the surgeon will often dissect the lymph nodes under the arm to see if the cancer has spread to them. This is important in staging how far the cancer has progressed.

Risky business: are lumpectomies dangerous or beneficial?

The obvious benefit to a lumpectomy is that you get to keep more of your breast tissue than with a mastectomy. It is less invasive and is usually done on an outpatient or short-stay basis. However, radiation is almost always necessary unless you are 70 years or older, the tumor was 2 cm or smaller with clear margins, the lymph nodes were negative and you are receiving hormone therapy. Other risks include pain, loss of feeling and hardened scar tissue. Depending on the size of the tumor, a lumpectomy can leave the breast severely malformed.

Going for it all: deciding on a mastectomy

Mastectomy is the total removal of the breast, but this surgery is performed a few different ways. A simple or total mastectomy removes the breast tissue plus the nipple. A modified radical mastectomy includes the lymph nodes from the underarm. A radical mastectomy removes the pectoral, or chest, muscles that extend into the underarm. This is the most extensive surgery and is not done as often. The modified radical mastectomy is just as effective in cancer survival rates.

Curing cancer: is mastectomy the best choice?

The main benefit from mastectomy is that you might avoid radiation therapy, according to Susan G. Komen for the Cure, but some women may still need it even with this procedure. It depends on how extensive the cancer is and how it has progressed systemically that will decide the role other cancer treatments play. Other risks include infection, pain, swelling to the arm associated with the lymph system and blood clots.

The survival rates between lumpectomy and mastectomy are about the same, but recurrence rates are slightly higher with lumpectomies. Choosing which surgery is best for you depends on your medical history, the stage and grade of your cancer, and your preferences for dealing with situations such as radiation and losing your breast. None of the choices in this are easy, but many people can support you in your decision, such as your health care team.

References:

• American Cancer Society; Surgery for Breast Cancer; February 2011
• Susan G. Komen for the Cure; Deciding Between Mastectomy and Lumpectomy; November 2011
• PubMed Health; Breast Cancer; December 2010
• PubMed Health; Mastectomy; January 2011

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