Lumpectomy vs. Mastectomy

What You Need to Know
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Once a doctor determines that a breast tumor must be removed, one of the first decisions the person you're caring for will have to make -- with the help of her medical team -- is how much breast tissue to remove. In some cases, doctors will recommend removing the entire breast, known as a mastectomy .

But women with early-stage tumors that haven't spread may choose breast-conserving surgery. Research shows that for stage I and II tumors, the long-term outcome from lumpectomy plus radiation or from mastectomy is the same, so doctors are likely to say the choice is yours. There are two breast-conserving options: lumpectomy or partial mastectomy.

Lumpectomy

In a lumpectomy, the surgeon removes only the breast tumor and a small margin of surrounding tissue. The goal is to make sure the tumor comes out with "clean margins," which means that the biopsied tissue shows no cancer calls remaining. (If the pathology report does not show clean margins, a re-excision or mastectomy may be necessary.)

A lumpectomy is almost always followed by five to six weeks of radiation therapy to catch any stray cancer cells.

Chemotherapy may also be recommended following surgery; this is known as adjuvant chemotherapy . Nowadays, though, based on encouraging results from recent studies, oncologists and surgeons are increasingly likely to recommend neoadjuvant chemo , which means that chemotherapy is given first to shrink the tumor before removing it surgically.

After lumpectomy or partial mastectomy

Like any surgery, lumpectomy or partial mastectomy has some risks, side effects, and recovery issues

Pain medication. You'll want to make sure the person you're caring for goes home with adequate pain medication. Ask her doctor to explain clearly what to expect in terms of pain and other possible reactions. Although lumpectomy is now often performed as outpatient surgery, it's still a major medical procedure and the patient is likely to be exhausted and uncomfortable for several days afterward

Surgical dressing and drains. The dressing over the wound may need to be changed, or there may be a drain in the breast area or armpit that requires care. Make sure you understand the procedure for emptying the drain, if the patient you're caring for is given one. And watch for signs of infection such as redness, swelling, and fever.

Physical therapy. Her doctor may recommend simple physical therapy exercises to prevent stiffness in the arm and shoulder on the side where the tumor was removed. These are important after a lumpectomy or partial mastectomy, so ask for written instructions and make sure the patient understands the exercises -- it can help to run through them together.

Partial mastectomy

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.


9 months ago, said...

Choose lumpectomy! Lumpectomy without radiotherapy is the best choice of breast cancer therapy irrespective of tumor stage and estrogen receptor status of tumor. According to the results of prospective studies, breast conservation without radiation ensures the best tumor-free life expectancy. Appropriate estrogen receptor (ER)-signaling is the chief safeguard of genomic stability in strong interplay with DNA-controlling and repairing systems, such as BRCA-genes and their protein products [http://goo.gl/EsB1bK]. The preserved mammary fatpad contains fibrous adipocytes, which are capable of aromatase synthesis and ensure the local defensive estrogen concentration against residual tumor cells. In addition, natural estrogen substitution is optimal risk-reducing therapy aiming the stabilization of gene regulatory processes and the apoptotic death of accidentally initiated tumor cells [http://dx.doi.org/10.2147/dddt...]. Dr. Zsuzsanna Suba


about 2 years ago, said...

I had a lumpectomy and then 6 weeks of radiation. If I had to do over again I would not do the radiation. As it has caused me to have constant pain on my right side of body for the rest of my life. Never again!!! And there is nothing they can do. And they don't help you at all with the pain.


over 2 years ago, said...

This is a sore spot with me. My wife went through this, she was told the same lie about keeping her breast. She had a lumpectomy and then radiation. The lumpectomy route is brutal. They stick needles into the tumor to mark it and then follow the needle down to the mass. Usually without any anesthetic. Then comes the radiation, which burns the breast and changes it permanently, AND it has a whole in it from the lumpectomy. The surest way to save your life is to lose your breast, which my wife did NOT do. She died after six years of misery. I believe had she had the mastectomy immediately she would still be alive and able to see the grandkids she would surely be adoring if she had lived.


about 4 years ago, said...

You did not define a "partial mastectomy". As a mammographer, I need to know the difference. Our hospital pathologists use the term "partial" but that seems to have no real distinction from a lumpectomy except the negative connotation to the affected patient of hearing the word "mastectomy". From a mammographer's viewpoint a partial means there is still tissue that needs to be re-checked and the doctors who use indiscriminate definitions do not help their patients get the correct follow-up treatment.


over 4 years ago, said...

I found this site very helpful in my continual quest for much needed answers to my myrid questions. Almost like sitting with a Dr. It is better to be aware of what to expect than to just walk in blindly. I will suggest to my friends this site. I am glad I found it. This and a walk with God, the two are worry relievers. Course nobody beats, the Rez.!!!!


over 4 years ago, said...

This site is a very good one to find out what to be expecting when one goes thru this thing called"Cancer" . The fewer surprises the better. We have enough on our plate.Answers for questions needing Answers from a reliable source. Thank goodness I found it.


almost 5 years ago, said...

I also want to know the kinds of chemo , etc. recommended,


almost 6 years ago, said...

This article gives a very clear picture of why a woman might make her choices. I would add that if wondering about the sexual affects of a mastectomy, a woman needs to realize that she will never feel the reconstructed breast again and the nipple would be gone and so there is no stimulation or sensation. Many times a woman's chest remains numb from her ribs to her collar bone as all of those nerves have been severed in the mastectomy. It can have a very big impact sexually and one should not underestimate this. Keeping the healthy breast was my choice as i did not have a choice on the cancerous breast due to two tumors being there too far apart from one another.


about 6 years ago, said...

I have just been diagnosed with breast cancer i am 30 years old and i have two teen agers and an 11year old. I have begun treatment with my doctor and i saw a surgeon the other day is it best to have it removed if the lump is very small or should i just have radiation?