It's not easy to decide between a lumpectomy vs. mastectomy. Cancer is daunting, and having to choose treatments can be difficult. But it's comforting to know that for many forms of early breast cancer, both procedures are good options.
Amy Wandel, M.D., a plastic surgeon who specializes in reconstructive surgery at Mercy Medical Group, a service of Dignity Health Medical Foundation, shared some of the details of these two surgeries and how they differ.
Many women who have breast cancer today are diagnosed early, which means they can choose a lumpectomy or a mastectomy to treat their Stage 1 or Stage 2 cancer. The long-term survival rates with a mastectomy or a lumpectomy are equivalent, Dr. Wandel said, so the decision comes down to personal preference.
A mastectomy is the removal of the entire breast, and also frequently involves removing a sampling of the lymph nodes in the arm pit. A lumpectomy involves removing the breast cancer and the breast tissue around the cancer. The amount of tissue around the cancer that is taken is determined by the size of the cancer. Frequently, surgeons will also perform a lymph node sampling with the lumpectomy. Lumpectomies are typically followed with radiation to make sure any remaining cancer cells in the breast tissue are destroyed.
"Frequently, the decision to have either a mastectomy or a lumpectomy is a decision based on emotional, as well as physical, considerations," Dr. Wandel explained.
Some women choose a mastectomy because they want to avoid radiation treatment altogether. But women should make sure they won't need radiation anyway, since the recommendations for radiation have been expanding in recent years.
"Ten years ago, women were choosing a mastectomy to avoid radiation," Dr. Wandel said. "Now, women who have mastectomies with a close margin — meaning the distance between the cancer and normal tissue is very small — may be offered radiation, as well as women who have positive lymph nodes."
In some cases, women can choose to get reconstructive surgery at the same time as the mastectomy, allowing them to get all the surgeries behind them faster and move on to healing. Women who choose mastectomies are frequently candidates for immediate reconstruction. For some women, this immediate reconstruction offers them the benefit of recreating a normal appearing breast earlier in their overall cancer treatment.
In general, women who choose mastectomies have more reconstruction options after the surgery than women who get lumpectomies. In some cases, women may even qualify for a nipple-sparing mastectomy, which provides an even more natural-looking breast after reconstruction.
The downside of mastectomies is that they tend to involve a longer downtime than lumpectomies. The mastectomy by itself will require about four weeks of downtime, and then the reconstructive surgery that you choose may add additional time.
Some women choose a lumpectomy because they want to preserve as much of their breast tissue as possible. However, it's important to know that the accompanying radiation may cause some unexpected changes, Wandel explained.
The surgery may leave the woman's breast slightly smaller than the other. Radiation can make tissue stiffer and less able to recover from injury. It may distort the nipple, contract the area, and leave the breast looking misshapen. As a result, your bra and clothes may not fit as well.
This doesn't happen with every woman, however, and the results of radiation can be unpredictable. "Some women go through radiation therapy and you can't tell they've had it," Dr. Wandel said. "Other women go through radiation therapy and it distorts their breasts significantly."
There are many benefits to lumpectomies. Frequently, doctors don't have to take the nipple-areolar complex, and the nerves going to the complex can be preserved. You may end up with a nice-looking breast that's just slightly smaller. And the downtime for a lumpectomy is far less than for a mastectomy.
A lumpectomy has a downtime of about a week, and then you're back to most of your normal activities. Radiation may be a six-week process, but you can typically still do most of your normal activities during treatment. Many women choose lumpectomies because they offer the quickest way back to normal activities.
When debating lumpectomy vs. mastectomy, talk to your doctor first to make sure that you're a candidate for both. Then compare the options, and determine which better fits your ultimate goals. For many women, either choice is a perfectly good treatment, and it really comes down to which will help you feel as healthy and whole as possible.
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