Breast Cancer

Understanding the differences between mastectomy and lumpectomy

Two different surgical options both seeking the same outcome

Once the shock of being diagnosed with breast cancer has subsided, it is time to understand available treatment options and make a plan. While the proposed treatment course will be based on multiple factors that could include type of hospital and patient age, surgery to remove the tumor is almost certainly part of the plan. When it comes to knowledge of breast cancer surgeries, most women are familiar with the term mastectomy, which is the total removal of a breast that has the cancer. A less aggressive surgical option is known as a lumpectomy and this approach conserves the breast as only the tumor is removed. Radiation treatment follows the procedure.

Outcomes following either procedure are very similar in terms of high overall survival, and low recurrence rates. Recurrence is estimated to be about a 10% risk in the treated breast, with either approach. Depending on the particulars of a patient's case, both options and their related pros and cons, might be presented to the patient to evaluate and decide.

What are some of the factors that might influence which surgical route to take?

Concern over re-occurrence. For a patient prone to anxiety or one that has past experiences with family members succumbing to cancer in any form, fear of the cancer coming back could be consuming. Since mastectomy removes all breast tissue, there is essentially nothing left to become cancerous. This approach is more invasive with different recovery time and possible breast reconstruction down the line, but some view peace of mind as an important tradeoff.

Concern over physical appearance. Depending on age and profession, some patients may be focused on impact to their body's appearance more than immediate concerns about cancer regrowth. If the prognosis is very good for the patient as a result of early detection and favorable genetics, there may be high confidence to elect the less invasive approach. Though lumpectomy will also require several sessions of radiation therapy, the preservation of breast tissue helps maintain overall breast size and symmetry.

Physician attitudes and experiences. Physicians who completed trained prior to the widespread introduction and acceptance of lumpectomy may tend to promote mastectomy more often based on their past experiences. Understanding how many of each procedure have been completed by the doctor and/or oncology team along with outcomes are important data inputs for this decision. Some hospitals share data relative to procedure volumes on their website or materials; this information can help to guide a conversation with the team.

Regardless of which surgical option a patient pursues, there is recovery time and the potential for follow-up procedures in the future. The total timeline and impact to one's quality of life is also important to understand during this decision making. Both approaches will require a hospital stay; it is possible with lumpectomy that the surgeon may need to remove more cells in a secondary procedure depending on what the pathology findings are. Then the radiation component will necessitate multiple return visits following the completion of recovery.

Mastectomy as a more invasive procedure has a longer recuperation period and then the topic of whether or not to undergo reconstructive surgery is another decision point; will the patient want to undergo another surgery with a different team and more associated recovery time?

Certainty other factors will influence the surgical decision a breast cancer patient makes when given a choice, thankfully both approaches are mature, well tolerated and tend to be successful. Only the patient can decide which is best for the desired journey.

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Published Date July 07, 2023