If surgery to remove breast cancer is a part of your treatment plan, you’re likely to have a lot of questions about what’s best for you. There are two primary types of surgery to remove breast cancer: a lumpectomy also called breast-conserving surgery and a mastectomy which removes the entire breast. There are important differences between the two surgeries and what’s best for one patient may not be right for another. Let’s take a look at these two types of breast cancer surgeries and how you and your breast cancer care team will decide how to move forward.
What is a Lumpectomy?
A lumpectomy removes the cancer and a small amount of healthy tissue surrounding it, called the margin. Removing a margin of healthy tissue helps ensure that all cancer cells have been removed. This is also referred to as breast-conserving surgery because the remaining healthy breast tissue is left intact.
Most women who have a choice prefer the less invasive lumpectomy. Research shows that lumpectomy plus radiation therapy treatment is just as effective as mastectomy for most women with early-stage breast cancer. Removing all the breast tissue (mastectomy) isn’t considered more effective for patients who qualify for a lumpectomy.
If a lot of breast tissue was removed to be sure the cancer was completely removed, it can affect the breast’s appearance. The breast cancer surgeon may be familiar with oncoplastic lumpectomy techniques that use plastic surgery methods to reshape the breast and make it look as symmetrical with the other breast as possible.
Radiation therapy is recommended after lumpectomy to help reduce the risk of the cancer coming back (recurrence). Good candidates for radiation following a lumpectomy:
Have early-stage breast cancer that hasn’t spread beyond the breast or underarm lymph nodes
Have one relatively small tumor
Prefer to keep as much natural breast tissue as possible
Want to avoid mastectomy and breast reconstruction
Can commit to daily radiation treatments over a period of a few weeks
Pros and Cons of a Lumpectomy
Advantages of lumpectomy:
Preserves your breast, including its appearance and sensations
An easier and shorter recovery time
Usually, a one-day procedure that lets you return home following surgery
Preserves the potential to breastfeed
Disadvantages of lumpectomy:
Radiation therapy is usually required. Typical sessions are five to seven weeks, five days a week, and can affect the timing of reconstruction surgery.
Radiation therapy has potential side effects: skin and breast tissues become thicker and less stretchy; skin darkening; or scar tissue inside the breast and chest muscles.
Scars, indentation, dimpling, or other changes may become noticeable over time as the skin heals.
The chance that some cancer cells are left in the breast after surgery and radiation. About 15% of lumpectomy patients require a second surgery because of cancer cells found in the margins.
Fluid buildup in the space where the tissue was removed (seroma) is normal after surgery; it may require draining.
What is a Mastectomy?
Mastectomy is breast cancer surgery that removes the cancer by removing the entire breast and sometimes tissue in the chest wall area. Most often only the breast that had cancer will be removed. For some patients with a genetic mutation that makes them more likely to have breast cancer recurrence, both breasts may be removed even though cancer was only found in one. This is a preventive mastectomy and is only suggested if you’re in this high-risk category.
Breast reconstruction may be done simultaneously as the mastectomy (immediate reconstruction) or at a later date after healing is completed (delayed reconstruction). Most of the breast skin, nipple, and areola will be left intact with immediate reconstruction. If you prefer to “go flat,” surgical closure will create a smooth chest wall. Prosthetic breast forms can provide the appearance of breasts under clothing.
Pros and Cons of a Mastectomy
Advantages of mastectomy:
Some women have greater peace of mind knowing that breast cancer cannot return if the breast is removed.
Most women do not need radiation therapy after a mastectomy.
The reconstructed breast can be made to match the other breast.
If you have a genetic mutation that increases cancer risk in your other breast, both breasts are removed to reduce the risk.
If you were a candidate for breast reduction, your surgeon may be able to reduce the size of the healthy breast and then match the reconstructed breast to the smaller size.
Disadvantages of mastectomy:
Mastectomy surgery takes longer and is more extensive than lumpectomy resulting in a longer recovery time.
More post-surgery side effects than lumpectomy include pain and nerve pain, tenderness, swelling, limited mobility in the affected area, and blood accumulation at the surgery site.
Psychological effects from permanent loss of a breast.
Loss of sensation in the breast area or nipple area because nerves in the breast skin, nipple, and areola are damaged or removed during mastectomy.
Additional surgeries to reconstruct your breast after mastectomy may be needed, even if you have immediate reconstruction.
Breast reconstruction after mastectomy will require long-term maintenance. Implants typically need replacement every ten years. Additional surgeries may be needed to maintain symmetry between the reconstructed and natural breast.
Deciding Which Breast Cancer Surgery is Best for You
You will discuss the best option for you with the breast surgeon, who has consulted with the medical oncologist so they can review where the tumor is located, the stage of cancer, and your overall health condition.
For some women, breast cancer tumors can be reduced in size before surgery using chemotherapy or hormone therapy for a few months. If your medical oncologist suggests treatment before surgery, it’s for a good reason. By reducing the size of the tumor, there will be a smaller area removed in a lumpectomy. And if mastectomy was the only option before treatments, a lumpectomy could become an option if the tumor shrinks as expected.
When deciding about your surgery, consider these personal issues:
Do you want to keep your breast? If your condition allows for either surgery, you may prefer lumpectomy instead of mastectomy if that's important to you.
Do you want the same size breasts as much as possible? Most women have good cosmetic results with lumpectomy. Reconstruction is available for either surgical technique.
Are you anxious about breast cancer recurring? Removing the entire breast may help reduce your anxiety.
Together you and your breast cancer care team will develop a treatment plan that’s best for you, including the type and timing of surgery.
Breast Cancer Surgical Oncology Services in Portland-Vancouver
The breast cancer specialists at Compass Oncology serve the Portland, OR - Vancouver, WA area providing advanced, personalized breast cancer treatment. Our cancer center is also a high-risk breast clinic for patients at increased risk of breast cancer. The dedicated oncology specialists, including our breast cancer surgeons on staff, will work as your team to answer your questions. Find a location near you to schedule your consultation.