Choosing a breast surgery is a completely personal decision.
“Most women [who] are diagnosed with breast cancer will have surgery at some point during their treatment,” says Jaime Alberty-Oller, MD, breast cancer oncologist and surgeon at the Dubin Breast Center at Mount Sinai Hospital. “My job as a breast cancer surgeon is to present a patient with her options…to be able to tell them when they can or cannot get one surgery over the other.”
Many women with early-stage breast cancers can choose between breast-conserving surgery and mastectomy. “There are clear differences between both surgeries, in terms of recurrence, cosmesis, how it’s going to make them look, [and] how it’s going to make them feel,” says Dr. Alberty-Oller.
Breast-conserving surgery—also called a lumpectomy, quadrantectomy, partial mastectomy, or segmental mastectomy—is a type of breast surgery where, instead of removing all of the breast tissue, a portion of the breast is removed. The surgeon will remove the cancer, as well as a rim of normal tissue surrounding it, which is called the margin. Learn more about lumpectomy here.
Breast-conserving surgery gives a woman the opportunity to keep most of her breast. The look of the breast, however, will depend on many factors.
“When you decide if a patient is a candidate for a lumpectomy, the most important thing that you are looking at is what we call breast-to-tumor ratio. You’re looking at the size of the breast and the size of the cancer,” says Dr. Alberty-Oller. For example, if you remove a large cancer from a small breast, sometimes the breast won’t look the same as it did before surgery. If it’s a larger breast with a small cancer, it may look a lot like it did before surgery.
“It’s very individualized, but I would say the majority of patients that have very small cancers are very good lumpectomy candidates and their breasts will look pretty much the same as they did before surgery,” says Dr. Alberty-Oller.
Mastectomy is the removal of the entire breast to treat or prevent cancer. There are different types of mastectomy surgery, including a total mastectomy, skin-sparing mastectomy, nipple-sparing mastectomy, and modified-radical mastectomy. In some cases, both breasts may need to be removed, which is called double mastectomy or bilateral mastectomy. Learn more about mastectomy types here.
For some women, mastectomy may be a better option, because of the type of breast cancer, the size of the tumor, previous treatment history, or other factors.
Choosing a Breast Cancer Surgery: Recurrence Risk
Some women might be worried that having one surgery over the other might raise their risk of the cancer coming back. “It’s important for them to know that we have studied this at length…and choosing a lumpectomy in most cases over a mastectomy will not be better or worse in terms of overall survival,” says Dr. Alberty-Oller.
For a mastectomy, since you remove the entire breast, the chances of the cancer coming back are lower. “They’re never zero, which is another thing we also have to explain to patients,” says Dr. Alberty-Oller.
For breast-conserving surgery, since you leave breast tissue behind, the chances of the cancer coming back are a little higher. “Still pretty low—in the range of five to 10 percent,” says Dr. Alberty-Oller.
Since a lumpectomy has a slightly higher chance of recurrence, it’s often married with the idea of getting postoperative radiation. Radiation essentially “mops up” microscopic cancer cells that may have been left behind during surgery. “If a patient has any medical conditions that would preclude them from getting radiation, then they would need a mastectomy from the get-go,” says Dr. Alberty-Oller.
When choosing between breast conserving surgery or a mastectomy, it’s important to discuss the pros and cons with your doctor. Bring a list of questions and concerns to discuss at your appointment so you can get all the information you need to make the best decision for you.
“Choosing a surgery, if they are a candidate for both, is a completely personal decision, and I think that that’s a decision that the patient should make with her partner, with her family, with her social system, and with herself,” says Dr. Alberty-Oller.
Oncoplastic techniques in breast-conserving surgery. UpToDate. (Accessed on November 20, 2019 at https://www.uptodate.com/contents/oncoplastic-techniques-in-breast-conserving-surgery)
Mastectomy: Indications, types, and concurrent axillary lymph node management. UpToDate. (Accessed on November 20, 2019 at https://www.uptodate.com/contents/mastectomy-indications-types-and-concurrent-axillary-lymph-node-management)
Surgery for Breast Cancer. American Cancer Society. (Accessed on November 20, 2019 at https://www.cancer.org/cancer/breast-cancer/treatment/surgery-for-breast-cancer.html)