Lumpectomy vs. Mastectomy: Page 2
Removal of a larger amount of breast tissue is called a segmental mastectomy, partial mastectomy, or quadrantectomy, because typically about a quarter of the breast tissue is removed. (The terms get confusing, because a lumpectomy is also sometimes called a partial mastectomy.) In this procedure, the surgeon removes the tumor and some of the surrounding tissue and may also remove a portion of the chest wall behind the tumor.
Depending on the amount and location of the tissue being removed and the patient's preferences, a plastic surgeon can perform reconstruction to preserve the shape of the breast. The most common procedure is called breast remodeling and involves rounding the breast out into a smaller one that preserves the natural shape. (The opposite breast may then be sized down to match.)
Another technique involves using tissue from another part of the body to augment the area of the breast where tissue was removed.
Depending on the type of reconstruction and other factors, reconstruction can be done either at the same time as the quadrantectomy or in a separate procedure. If reconstruction is done separately, it's advisable to do that before radiation, since surgery will be more successful on tissue that hasn't been exposed to radiation.
Reasons to choose lumpectomy or partial mastectomy over mastectomy:
- The tumor is less than 5 centimeters across.
- The tumor is small in proportion to overall breast size.
- The tumor is not directly behind the nipple, so the nipple can be saved.
- The woman wishes to keep as much of her natural breast as possible for cosmetic reasons.
- The patient or her partner feels strongly about keeping the breast for sexual reasons.
- The woman doesn't have a family or genetic history of breast cancer.
Reasons not to choose lumpectomy:
- Anxiety over whether the cancer is completely gone can persist.
- If the lump is large or the breast is small, the cosmetic result may not be desirable.
- There are multiple small tumors.
- In most cases, radiation must follow and can have side effects.
- Radiation therapy requires daily appointments for five to six weeks, posing scheduling challenges.
- The patient has had radiation previously to the same breast.
Radiation and Older Women
In some cases, experts don't consider radiation after lumpectomy necessary for women over 70, in whom cancer grows more slowly. This takes the radiation issue out of the decision about whether to have a lumpectomy or quadrantectomy.