A cancer diagnosis can be overwhelming, and when the diagnosis is breast cancer, a woman often has to make very personal decisions with respect to her treatment, particularly when considering surgery. Surgery is usually necessary for nearly all breast cancer patients; treatment for breast cancer is usually a combination of surgery, radiation therapy and sometimes chemotherapy and/or hormone therapy.
Depending on the extent of the cancer, the surgical oncologist may recommend a mastectomy, which is a surgery to remove nearly all of the breast tissue. However, for a woman with early-stage cancer (breast cancer that has not spread beyond the breast or the lymph nodes), there are typically several options, and with those options come choices. Does she want to conserve as much of the breast as possible and only have the diseased tissue removed? Does she want the entire breast removed? Does she want breast reconstruction surgery? Does she want implant-based reconstruction, or does she want to use her body’s own tissue to recreate the breast?
Surgical options include:
- Lumpectomy — a surgical procedure in which only the part of the breast containing the cancer is removed. A lumpectomy is considered a breast-conserving surgery.
- Mastectomy — a surgical procedure in which nearly the entire breast is removed, including diseased and healthy tissue. A double, or bilateral, mastectomy is when both breasts are removed.
- Implant-based reconstruction — a surgical procedure that restores shape to the breast after a lumpectomy or mastectomy using silicone or saline implants.
- Autologous tissue reconstruction — a surgical procedure that uses a person’s own tissue (skin, fat, muscle) from another part of the body (typically the abdomen or back) to reconstruct the breast.
- Oncoplastic reconstruction — is a combination of surgical oncology and plastic and reconstructive surgery. Generally, this approach is suitable for women who have larger areas of diseased breast tissue but still have enough healthy breast tissue for the breast to be restored to its natural appearance.
Factors to consider:
Radiation therapy
There is a small risk of recurrence of breast cancer for either approach, lumpectomy with radiation therapy or mastectomy. The risk is dependent on different tumor characteristics, but it is less than 10%.
Research has shown that outcomes for mastectomy and lumpectomy are essentially identical. While the lumpectomy only involves partial removal of the breast, the surgery is usually followed by four to six weeks of radiation therapy to kill any remaining cancer cells and reduce the risk of recurrence. A mastectomy may or may not be followed by radiation therapy, depending on the number of cancer-positive lymph nodes a woman has and other factors particular to her breast cancer.
Impact of the surgery on life
There are short and long-term factors to consider when deciding which surgery is right for you. Ask your doctor about the expected recovery time for each option, restrictions after surgery and if there are any additional procedures needed.
Post-treatment disease surveillance
A woman who has a lumpectomy must continue to get mammograms of that breast. Women who get mastectomies no longer need routine breast imaging, since the breast tissue has been removed, but they require regular physical exams to check for nodules or other changes.
Family history
Between 5% and 10% of breast cancers are hereditary. Gene mutations (abnormalities that occur when cells divide) can be inherited from a parent. If there is a history of breast cancer in your family, your doctor may recommend meeting with a genetic counselor and undergoing genetic testing to determine if your disease is associated with an inheritable genetic abnormality. Women with certain genetic mutations have an increased risk for the development breast cancer. In these cases, women still have the option of breast conservation but may opt for a mastectomy because of a higher risk of recurrence. Depending on the type of genetic mutation, additional methods of managing the increased risk, such as preventive removal of the ovaries, may be recommended.
Making an informed decision
It is important to meet with the members of your treatment team (surgical oncologist, radiation oncologist, medical oncologist and plastic surgeon) to understand all of your options, your risk of recurrence and how treatment will impact your life and that of your family in the future.
After your medical team has determined your options based on factors such as the stage of your cancer, type of breast cancer, imaging scans and any inherited mutations, your decision often comes down to personal preference and what makes the most sense to you. Consider the information, ask questions and take the time you need to gain clarity. By taking these steps, you will have the tools you need to make the right decision for you.
