When a woman is faced with breast cancer, there are two choices available: lumpectomy and mastectomy.
Lumpectomy is less invasive than mastectomy and it allows a woman to
save her breast. Mastectomy involves removal of the entire breast.
Most women, when offered the choice between the two, prefer the less
invasive lumpectomy Generally, lumpectomy results in a good cosmetic
look. And, if you want to keep your breast, you may decide to have
lumpectomy followed by radiation. However, in rare cases, when a larger
area of tissue needs to be removed, lumpectomy can cause the breast to
look smaller or distorted. There are types of reconstructive surgery
available for both lumpectomy and mastectomy. If you need to have a
large area of tissue removed and two breasts of matching size are very
important to you, you and your doctor will need to decide which surgery
is best for your situation.
Research shows that women who live in the United States are more likely
to have mastectomies than women who live in other countries. In the
Midwestern and southern parts of the U.S., mastectomies are very common.
Lumpectomy followed by radiation is likely to be equally as effective as
mastectomy for women with only one site of cancer in the breast and a
tumor under 4 centimeters. Clear margins are also a requirement (no
cancer cells in the tissue surrounding the tumor).
Lumpectomy has a few potential disadvantages:
Radiation therapy is likely to be scheduled for 5 to 7 weeks of
radiation therapy– 5 days per week after lumpectomy surgery to make sure
the cancer is gone.
Radiation therapy may affect the timing of reconstruction and possibly
your reconstruction options after surgery. Radiation therapy also may
affect your options for later surgery to lift or balance your breasts.
There is a somewhat higher risk of developing a local recurrence of the
cancer after lumpectomy than after mastectomy. However, local
recurrence can be treated successfully with mastectomy.
The breast cannot safely tolerate additional radiation if there is a
recurrence in the same breast after lumpectomy. This is true for either
a recurrence of the same cancer, or for a new cancer. If you have a
second cancer in the same breast, your doctor will usually recommend
that you have a mastectomy.
One or more additional surgeries may be needed after your initial
lumpectomy. During lumpectomy, the surgeon removes the cancer tumor and
some of the normal tissue around it (called the margins). A
pathologist looks to see if cancer cells are in the margins. If there
are cancer cells, more tissue needs to be removed until the margins are
free of cancer. Ideally, this is all done during the lumpectomy, but
analyzing the margins can take about a week. So sometimes after the
pathology report is done, the margins are found to contain cancer cells
and more surgery (called a re-excision) is needed.
Some women may want the entire breast removed because it provides a
greater peace of mind regarding the recurrence of breast cancer.
Radiation therapy may still be needed, depending on the results of the
pathology.
Mastectomy means that the woman will have a permanent loss of her breast
and that she will have to have additional surgeries if she chooses to
have her breast reconstructed. A mastectomy takes longer than a
lumpectomy and is more extensive. It also has more post-surgery side
effects and a longer recuperation time.
The choices are personal so be sure to weigh your decision carefully after you’ve talked with your doctor.
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