Which to choose – lumpectomy vs. mastectomy? These two different types of surgeries used to treat breast cancer sometimes cause confusion during an already difficult time. Most women have probably never thought in great detail about these two procedures and how they differ, and hoped that they would never have to. After a breast cancer diagnosis however, the decision between Lumpectomy vs. Mastectomy is suddenly glaring you in the face and there is no hiding from it. This is a scary and confusing time for any woman, and is often filled with indecision and anxiety. Making decisions regarding breast cancer treatment is no doubt an emotionally difficult time, so it is important to step back, take a breath and do your research. Arming yourself with knowledge about your options is the best way to put your mind at ease and feel more comfortable moving forward with whatever decision you make regarding Lumpectomy vs Mastectomy surgery. There are pros and cons to each surgery, for women with early invasive breast cancer however, both Lumpectomy and Mastectomy surgery have proven to be effective means of treatment for eradicating the cancerous area. Dr. Spiegel helps women understand which options might be best for individual circumstances and desired outcomes.
What is Lumpectomy Surgery?
A Lumpectomy is a form of breast-conserving surgery that only removes the cancerous area and some of the surrounding normal tissue. This procedure is also known as a “partial mastectomy”. Lumpectomy followed by radiation treatment is the most commonly performed form of breast cancer treatment. Large studies have shown that survival rates of Lumpectomy vs Mastectomy are similar, with Lumpectomy often rendering a more desirable post-op cosmetic result. However, results rely heavily on individual factors and are dependent on the amount of tissue that needs to be removed. While a Lumpectomy is less disfiguring than a Mastectomy and typically does not require breast reconstruction post-operation, the procedure can still cause significant changes in the appearance of your breast if a large amount of tissue must be removed. In these cases, there are reconstructive techniques that can help correct significant contour abnormality that can occur as the result of lumpectomy surgery. Women with a greater volume of breast tissue tend to make better candidates for reconstruction after lumpectomy. Women with smaller breasts who might have more significant breast distortion may go on to have completion mastectomy or flap reconstruction for improved cosmetic results.
For lumpectomy reconstruction candidates, as long as the surgical margins are clear of tumor and the excision is large enough to cause a significant defect after radiation changes are complete, then reconstruction can be completed utilizing flaps, which are made of local skin and fat, or by using tissue from the abdomen. It is important to remember that radiation changes can and often occur over the course of three years. So, a lumpectomy defect that is small and initially acceptable can change over time and may create an undesirable deformity.
What is Mastectomy Surgery?
Up until a few decades ago, mastectomy was the only surgical treatment option available to breast cancer patients. In this procedure, one or both of the breasts are entirely removed. There are essentially five different types of mastectomies, but the most frequently performed is the total mastectomy, in which all of the breast tissue is removed from the affected breast, including the areola and nipple. However, there are more advanced methods of skin and nipple sparing mastectomies that can be performed, which also leave the muscle under the breast intact.
This surgery is often chosen in high-risk cases with the intention of avoiding the disease altogether. This procedure may be preferred for cases where the patient has already undergone radiation, multiple areas of cancer are detected in the breast, the patient is pregnant or has had lumpectomies in the past that were unsuccessful in completely eliminating the cancer.
Deciding Between Lumpectomy and Mastectomy
There are many elements to consider when looking at lumpectomy vs mastectomy for treatment of breast cancer. Many women will opt for a mastectomy out of fear that the cancer will return, or because they do not want to undergo weeks of radiation. Radiation therapy is almost always recommended after a lumpectomy procedure. Supplementing the procedure with radiation has been shown to significantly reduce the risk of cancer returning in the breast (local recurrence).
This is an immensely personal decision for any woman to make, but your surgeon will be able to counsel you on the comparative statistics and advise you on which procedure will benefit you best in the long term. While many women will choose to have a mastectomy to avoid radiation and put their minds at ease regarding recurrence, some women may experience negative psychological consequences as a result of losing one or both breasts. For a number of women, their breasts represent a semblance of femininity and sexuality, and today the availability of breast reconstruction can help ease the negative side of a mastectomy. The emotional implications of undergoing a mastectomy are important factors that every breast cancer patient will have to contemplate.
Fortunately, as great medical advancements have been made in the area of breast cancer diagnosis and treatment, so too has the field of breast reconstruction. Newer and more sophisticated breast reconstruction techniques like the DIEP Flap procedure are able to use the patient’s own skin and fat from the abdominal region to create a new breast that looks and feels more natural than an implant. Dr. Spiegel’s expertise in this area truly helps women regain that confidence and femininity that can sometimes be lost after a breast cancer diagnosis.