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Surgery For Breast Cancer

Choosing Between Lumpectomy and Mastectomy

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© American Cancer Society 2010

Many women with early-stage cancers can choose between breast-conserving surgery and mastectomy.

The main advantage of a lumpectomy is that it allows a woman to keep most of her breast. A disadvantage is the usual need for radiation therapy -- most often for 5 to 6 weeks -- after surgery. A small number of women having breast-conserving surgery may not need radiation while a small percentage of women who have a mastectomy will still need radiation therapy to the breast area.

When deciding between a lumpectomy and mastectomy, be sure to get all the facts. You may have an initial gut preference for mastectomy as a way to "take it all out as quickly as possible." Women tend to prefer mastectomy more often than their surgeons do because of this feeling. But the fact is that in most cases, mastectomy does not give you any better chance of long-term survival or a better outcome from treatment. Studies following thousands of women for more than 20 years show that when a lumpectomy can be done, mastectomy does not provide any better chance of survival than lumpectomy.

Although most women and their doctors prefer lumpectomy and radiation therapy when it's a reasonable option, your choice will depend on a number of factors, such as:

  • how you feel about losing your breast
  • how you feel about getting radiation therapy
  • how far you would have to travel and how much time it would take to have radiation therapy
  • whether you think you will want to have more surgery to reconstruct your breast after having a mastectomy
  • your preference for mastectomy as a way to 'get rid of all your cancer as quickly as possible
  • your fear of the cancer coming back

For some women, mastectomy may clearly be a better option. For example, lumpectomy or breast conservation therapy is usually not recommended for:

  • women who have already had radiation therapy to the affected breast
  • women with 2 or more areas of cancer in the same breast that are too far apart to be removed through 1 surgical incision, while keeping the appearance of the breast satisfactory
  • women whose initial lumpectomy along with re-excision(s) has not completely removed the cancer
  • women with certain serious connective tissue diseases such as scleroderma or lupus, which may make them especially sensitive to the side effects of radiation therapy
  • pregnant women who would require radiation while still pregnant (risking harm to the fetus)
  • women with a tumor larger than 5 cm (2 inches) across that doesn't shrink very much with neoadjuvant chemotherapy
  • women with inflammatory breast cancer
  • women with a cancer that is large relative to her breast size

Other factors may need to be taken into account as well. For example, young women with breast cancer and a known BRCA mutation are at very high risk for a second cancer. These women may want to consider having a mastectomy, or even a double mastectomy, to both treat the cancer and reduce this risk.




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