Let's Talk About Surgery

Once cancer has been confirmed by biopsy, most women are eager to start treatment with surgery right away. There are two basic options—lumpectomy and mastectomy. Interestingly, a lumpectomy plus radiation offers the same survival rate as a mastectomy, so the decision is often based on which surgery will produce the best cosmetic result. If a lumpectomy is going to leave your breast looking distorted, a mastectomy with reconstruction may actually be a better option. Here, a breakdown of your choices:

Lumpectomy

The basics: A surgeon removes the cancerous lump, plus a small border of surrounding tissue. The surrounding tissue is examined, and if cancer cells are found, further surgery is performed until there is a cancer-free margin of tissue. Sometimes, doctors recommend chemotherapy before surgery, in the hope that a larger tumor will shrink enough to make a lumpectomy doable. This is called neoadjuvant therapy (treatment before the main treatment). Lumpectomy is nearly always followed by radiation to reduce the chance of a local recurrence.

It may be right for you if: You have one tumor and it's small enough that removing it will not affect the shape of your breast.

Mastectomy

The basics: A surgeon removes all the glandular tissue of the breast. During a mastectomy, the surgeon makes an oval-shaped incision and removes the nipple, breast tissue and some of the skin. When breast reconstruction is planned, the surgeon may make a smaller incision and hollow out the breast, preserving most of the skin—and in some cases, the nipple itself. This is called a nipple-sparing mastectomy. The type of mastectomy performed depends partly on the extent of the cancer. In a total (simple) mastectomy, only the breast is removed. In a modified radical mastectomy, some underarm lymph nodes are removed as well.

It may right for you if: Your tumor is large compared to the size of your breast, there is cancerous tissue in more than one area of your breast, you're in the early stages of pregnancy or have an active connective tissue disease (like lupus) that can make radiation risky.

Ultimately, it's up to you

Most women who are eligible for a lumpectomy choose it over a mastectomy. But that may not be the right choice for you. You may not want to prolong therapy by undergoing radiation, or you may simply feel more comfortable having your breast completely removed, especially if you have a family history of breast cancer or are at high risk for a recurrence. Your doctors will provide valuable advice and insight—but ultimately, the choice is yours.


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