We teach you about the surgical options available for treating breast cancer. There are distinct advantages and disadvantages with lumpectomy and mastectomy surgeries.

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Questions for your Breast Surgeon:

1. What are my surgical options?
2. What surgery do you recommend for me?
3. What is the difference in recovery?
4. How do the “local recurrence” rates differ?
5. Can you outline the possible complications of both surgeries?
6. Should I do “Genetic Testing” before surgery?
7. Lumpectomy vs. Mastectomy surgery options

A Lumpectomy (followed by radiation) for early stage breast cancer is generally considered the optimal choice because it is less invasive and has the same cure rates as a mastectomy. At surgery, the breast cancer “lump” is removed with a margin of normal tissue around it. You are able to keep your breast with a lumpectomy, but you will likely benefit from a course of radiation to that breast to lessen the risk of developing a recurrence of cancer in the lumpectomy area of the breast in the future. It is important to note that some may not be good candidates for a lumpectomy.

A Mastectomy (usually without radiation) for early stage breast cancer is a more involved surgery especially if breast reconstruction is performed. It is important to understand that multiple surgeries are often needed by a plastic surgeon to ultimately achieve a symmetric, cosmetic outcome. “Nipple-sparing” and “skin-sparing” mastectomy techniques can now achieve better cosmetic outcomes than in the past. One advantage is that you can generally avoid radiation for early stage breast cancer. A mastectomy does not generally improve survival rates compared to lumpectomy for early stage breast cancer.

Why is breast surgery a complex decision?

Every patient presents with a unique breast cancer situation. Your breast surgeon is the key person to understand what surgical options will serve you the best. Multiple cancer factors play into these options. This is a complex decision and recommendations may differ amongst surgeons. Most importantly, it is up to you to make a well-informed decision that suits you as a person and a patient.

Do I have time to decide what surgery is best?

This is a difficult time and one of information overload. You have plenty of time to learn more about your breast cancer and discuss your options with your breast surgeon. Taking a few weeks to make a decision has not been shown to have an effect on your cancer outcome. Early stage breast cancer usually can be managed with either a lumpectomy followed by radiation or a mastectomy alone. There are distinct advantages and disadvantages to both approaches. When you are well educated about your options, you will be better prepared to work with your breast surgeon to decide what surgery is best for you.

Myths and Facts about surgery and early stage cancer:

A mastectomy does not reduce the need for chemotherapy
Lumpectomy is an outpatient surgery
It generally takes 3 to 6 weeks to schedule a mastectomy with reconstruction
Genetic testing before surgery can sometimes alter your decisions
Breast radiation after a lumpectomy usually takes 4 to 6 weeks

Does a mastectomy increase my odds of survival?

A mastectomy does not increase your odds of survival for early stage breast cancer. This question has been studied in detail. If you have a lumpectomy and radiation, your chance of being alive ten years later is exactly the same as if you had a mastectomy without radiation. “Survival” is the most important cancer outcome we measure. It is the same for both treatment approaches for early stage cancer.

Why do some choose a mastectomy over a lumpectomy?

Most of the time this choice is a personal one for a variety of reasons. There are legitimate differences between the two surgical approaches involving recovery, side effects, complications, and costs. It is important to realize that everyone has different goals, unique personal situations, and their own reasons as to how they manage their health issues. “Patient autonomy” is essential to a great “doctor-patient” relationship. The more informed you become, the better decisions you will make for your own cancer situation.

Ask about BRCA Genetic testing before surgery.

You need to ask yourself this question, “If I have cancer and carry the BRCA mutation, would I change my mind about surgery and have both breasts removed to reduce my risks of having another new breast cancer in the future?” If the answer is yes or maybe, you should consider undergoing genetic testing before your recommended surgery. If the answer is no, then you can undergo testing after surgery.

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