Lumpectomy vs mastectomy: decisive factors

Many people with early-stage breast cancer may choose between breast-conserving surgery, called lumpectomy, or total breast removal, a mastectomy. They may also require radiation therapy.

In most cases, having a lumpectomy and radiation therapy gives a person a similar chance of long-term survival in the form of mastectomy.

Choosing between the two procedures involves many personal and medical factors, including the person’s medical history and concerns about recurrence and cosmetic issues.

In this article, we explain in more detail lumpectomies and mastectomies, including what they involve and the risk of recurrence. We also discuss some of the pros and cons of each option and list other treatment options for breast cancer.

Lumpectomies and mastectomies are similar surgeries, but they have different subsequent treatments and recovery times.

Mastectomy

During a mastectomy, a surgeon will remove the entire breast.

There are different types of mastectomies. According to American Cancer Society, these include:

  • Simple or total mastectomy: The surgeon removes the entire breast, including the skin, areola, and nipple. They can also remove some lymph nodes under the arms. Most people can go home the day after surgery.
  • Skin-friendly mastectomy: The surgeon will keep most of the breast skin intact and only remove the breast tissue, nipple, and areola. They will remove the same amount of tissue as with a simple or total mastectomy. The surgeon can then use tissue from other parts of the body or implants to rebuild Chest.
  • Nippleless mastectomy: The surgeon removes the breast tissue but keeps the skin and nipple intact. They can look for cancer cells in the breast tissue under the nipple. If they find cancer cells, they will also remove the nipple.
  • Modified radical mastectomy: This procedure involves the removal of the entire breast, as with a simple or total mastectomy. The surgeon will also remove the lymph nodes under the arms.
  • Radical mastectomy: During this surgery, the surgeon removes the entire breast, the lymph nodes under the arm, and the pectoral muscles under the breast. Surgeons tend to recommend smaller surgeries that have fewer side effects but are just as effective. However, they can still perform this surgery on people with large tumors growing in the pectoral muscles.
  • Double mastectomy: Surgeons can perform this surgery, in which they remove both breasts, as a risk reduction measure for people at very high risk of breast cancer. Most double mastectomies are either single or total mastectomies, but some can spare the nipples.

Learn more about the types of mastectomy here.

Lumpectomy

During a lumpectomy, a surgeon will remove the tumor from the breast and some of the healthy tissue around it. A lumpectomy is technically a partial mastectomy because it removes part of the breast.

The amount of breast tissue the surgeon removes depends on the size and location of the tumor and the size of the breast, among other factors.

For example, a person may have a type of lumpectomy called a quadrantectomy, in which the surgeon will remove approximately A quarter breast.

A person goes likely need radiation therapy after a lumpectomy, and they may also need other treatments, such as chemotherapy or hormone therapy.

A lumpectomy can cause scarring or dimpling in the area where the tumor was before it was removed. It can also lead to pain and sometimes a type of swelling in the arm area called lymphedema. Some people choose to have reconstructive surgery after the procedure.

Learn more about removing breast lump here.

Many people with breast cancer who have a choice of treatment prefer the less invasive lumpectomy to a mastectomy. Anyone who needs to make a decision has to consider a number of factors.

  • Keep the breast: A person who wants to keep the breast can opt for a lumpectomy with radiotherapy.
  • Reduced risk of recurrence: A person very anxious about the return of breast cancer may opt for a mastectomy. There is a higher risk local recurrence with lumpectomy than with mastectomy.
  • Lower cost: If a person is concerned about the cost of their treatment, they may choose a lumpectomy. A 2016 study found that a reconstructive mastectomy was much more expensive than the other options.
  • Cosmetic factors: For people who want their breasts to match as much as possible, a lumpectomy may be preferable, as this surgery usually has a good cosmetic result. However, reconstructive surgeries are usually possible after lumpectomies and mastectomies.

Some people with breast cancer are not candidates for a lumpectomy. A person will need to speak with their doctor to determine if a lumpectomy is a possibility for them.

Learn more about Medicare coverage for mastectomies here.

A surgeon may suggest lumpectomy to treat early, localized, or operable breast cancer.

A person may also need other treatments, such as radiation therapy, chemotherapy, and hormone therapy.

The advantages and disadvantages of lumpectomy include:

The pros of lumpectomy

  • Surgeons may be able to preserve the appearance of the breast to a greater extent and maintain most of the feel.
  • The surgery is less invasive, and people recover faster and easier.
  • Surgery is less expensive than a mastectomy.

Disadvantages of lumpectomy

  • People will likely need 5-7 weeks of radiation therapy after a lumpectomy.
  • If a person receives radiation therapy, it can affect the time of reconstruction and the options available.
  • People have a higher risk of local recurrence if they choose a lumpectomy rather than a mastectomy.
  • If it recurs, the breast cannot tolerate additional radiation therapy, so the healthcare team will likely recommend a mastectomy.
  • If doctors find other cancer cells in the breast after the initial surgery, more surgeries may be needed.

Advantages and disadvantages of mastectomy include:

The mastectomy pros

  • It can be reassuring to remove the entire breast and cancer site.
  • Radiation therapy is less likely to be needed than with lumpectomy.
  • There is less chance of recurrence than with lumpectomy.
  • It is less likely that a person will need additional surgery if they choose not to have breast reconstruction.

Cons of mastectomy

  • Mastectomies are more extensive than lumpectomies.
  • The healing process takes longer and a person may face more side effects after surgery.
  • People can find permanent breast loss overwhelming.
  • If the person chooses to have reconstruction, they will need additional surgeries.

A person may have other treatments for breast cancer, before or after surgery or without it. Treatment options include:

Radiotherapy

Radiation therapy uses x-rays or other types of radiation to kill cancer cells and prevent them from growing.

There is two types radiotherapy:

External radiotherapy

Doctors use this therapy to treat breast cancer. A machine outside the body directs the radiation to the cancerous area.

Internal radiotherapy

Doctors use this therapy, also known as brachytherapy, to relieve bone pain caused by breast cancer that has spread to the bones. The doctor injects a substance called strontium-89 into a vein, and it travels to the surface of the bones. The substance releases radiation that kills bone cancer cells.

Learn more about the side effects of radiation therapy for breast cancer here.

Chemotherapy

Chemotherapy uses drugs that healthcare professionals inject into a vein or muscle. People can also take oral chemotherapy drugs.

When the drugs enter the bloodstream, they reach cancer cells all over the body and kill them.

Learn more about oral chemotherapy for breast cancer here.

Hormonal therapy

This treatment delete hormones or prevents their actions, preventing cancer cells from growing.

Doctors can test a sample of breast tissue to check for the presence of hormone receptors on cancer cells. If these receptors are present, doctors may use surgery, radiation therapy, or drugs to reduce the production of hormones or prevent them from working.

Doctors may use a treatment called ovarian removal to stop the ovaries from making estrogen, the hormone that causes breast cancer to grow.

Targeted therapy

Doctors use targeted therapy to identify and attack specific cancer cells.

Targeted therapies may be less harmful to normal cells than other therapies, such as radiation therapy and chemotherapy. Therefore, in some cases, they can cause fewer side effects.

Doctors can give this treatment in the form of medication.

Immunotherapy

Immunotherapy uses the person’s immune system to fight cancer. It is a type of biological therapy.

Immunotherapy uses synthetic substances or substances that the body produces naturally to direct, restore or strengthen the body’s natural defenses against cancer.

Learn more about first-line treatments for breast cancer here.

Lumpectomies and mastectomies are both effective treatment options for early-stage breast cancer. A person’s choice between them often involves their personal preferences and medical history, as well as the type of breast cancer.

Both options have advantages and disadvantages. Some people may choose a lumpectomy to preserve the appearance of the breast, save money, or avoid more extensive surgery.

Others may choose a mastectomy to have peace of mind, reduce the likelihood of needing radiation therapy, or decrease the risk of recurrence.

Other treatment options are available that a person can receive before, after, or without surgery. These options include radiation therapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy.


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