Lumpectomy or Mastectomy Surgical Treatment Options for Breast Cancer
With many (especially early stage) breast cancer cases, surgery to remove the cancer is part of the treatment. Sometimes breast cancer surgery is performed after chemotherapy or hormonal therapy is given to shrink the tumor (neoadjuvant treatment). Breast cancer surgery removes the primary tumor and helps accurately stage the disease.
What is Breast Conserving Surgery (Lumpectomy or Partial Mastectomy)?
Breast conserving surgery involves removal of the cancer with a rim of normal tissue (negative margins). This leaves the breast intact, usually with a good cosmetic outcome. There is frequently some reduction in the size of the breast, or more frequently, a flattening of the contour of the breast in the area of the surgery.
There are two surgical options to remove the cancer but not the breast (breast conserving surgery):
- Lumpectomy – removal of the tumor or lump and some of the normal tissue around it.
- Partial Mastectomy – removal of the section of the breast that has cancer and some of the normal tissue around it.
Breast conserving surgery also typically includes a sentinel lymph node biopsy, in which the surgeon identifies and removes the sentinel lymph node (or first lymph node the cancer is likely to spread to) to determine whether or not cancer has spread.
Breast conserving surgery should be followed by radiation treatment in the majority of patients, otherwise there would be a very high risk of the cancer coming back in the same area (25-30% risk). Radiation treatment reduces this risk of local recurrence to 5-10% or less. Patients who receive a lumpectomy may be candidates for a one-time, targeted dose of radiation therapy called Intraoperative Radiotherapy (IORT). This treatment eliminates the need for patients to return to the hospital multiple times (typically an additional six) to receive radiation treatment.
All patients are not candidates for breast conserving surgery. In some cases, your doctor may recommend a mastectomy, or the removal of the entire breast that has cancer.
What is a Mastectomy?
A mastectomy is surgery to remove the entire breast that has cancer. A mastectomy is likely to be recommended if the breast cancer is too big, is located in the center of the breast, is large relative to the size of the breast, or is located in multiple different areas of the breast.
If a woman has to have a mastectomy, she can consider wearing a breast prosthesis in her bra, undergoing breast reconstruction surgery or neither one. Breast reconstruction surgery is performed to create a new breast using either implants or tissue from another area of the body.
The one benefit of a mastectomy is that most patients with early stage breast cancer do not require radiation. However with larger tumors, or if multiple lymph nodes are involved, patients need radiation treatment in addition to the mastectomy to reduce the risk of the cancer coming back.
A mastectomy also typically includes a sentinel lymph node biopsy, in which the surgeon identifies and removes the sentinel lymph node (or first lymph node the cancer is likely to spread to) to determine whether or not cancer has spread.
It is important to understand that there is no difference in survival with a mastectomy or lumpectomy. This is why patients are frequently given the choice, and they can decide which option suits them best. As noted above, there are instances where mastectomy is the only option.
