Breast Cancer Surgery Options

If you are reading this it is likely that you or a loved one has been diagnosed with breast cancer and you have some tough decisions to make.

You’ve just been told you have cancer. Your head is probably spinning. And your surgeon wants to know what kind of surgery you want.

Your first instinct is probably to just get it out as fast as you can, however you can.

But I encourage you to slow down and think. You’ve got time. This is an important decision and it’s worth educating yourself on your options.

First, you should know that there are 4 components of breast cancer treatment: surgery, chemotherapy, radiation, and endocrine therapy. I’ll also add a 5th component not traditionally discussed….lifestyle and nutrition.

In this article, I’d like to discuss your surgical options, as surgery is the first step of breast cancer treatment for most women. On occasion, chemotherapy may be recommended prior to surgery, but this is unusual in our area of the country.

Your options for surgery include having the entire breast removed (mastectomy) or just having the cancer removed while preserving the remainder of the breast (lumpectomy).

The important thing to know about these options is that both mastectomy and lumpectomy lead to EQUAL RATES OF CURE!!! The chance of recurrence within the breast after lumpectomy or mastectomy is less than 5%. That’s pretty darn good!

I have many women that come to me thinking that they want a mastectomy because they want to be as aggressive as possible “so they don’t have to worry about the cancer ever coming back”. These women are under the mistaken impression that if the breast is removed, it is impossible for the cancer to come back. Unfortunately, the cancer can come back in the tissue that is left behind after mastectomy. This is called a chest wall recurrence. It doesn’t happen often, but it does happen.

The important point here is that breast cancer returns in the soft tissue of the chest wall after mastectomy just as often as it returns in the remaining breast tissue after lumpectomy. So neither mastectomy or lumpectomy is more or less aggressive than the other when it comes to getting rid of the cancer in the breast.

Let me insert here that a double mastectomy (having both breasts removed) is very rarely indicated. Rates of double mastectomy have skyrocketed over the last several years even though there is no medical data indicating that double mastectomy improves prognosis. We suspect this is due to what is referred to as the “Angelina Jolie” effect. There have been a number of celebrities with the breast cancer gene (including Angelina Jolie) that have undergone double mastectomy and have been very public about it. This has led many women to follow suit, feeling like they are increasing their odds of beating the cancer by having both breasts removed. What the media doesn’t always make clear is that double mastectomy is only indicated if you have the breast cancer gene, which applies to less than 5% of women with breast cancer.

So now that you know that your choice of surgery doesn’t affect your prognosis, how do you decide which surgery is right for you.

Why choose mastectomy?

There are a number of reasons that a woman might prefer a mastectomy.

Unfortunately, the number one reason I see in my practice is that, despite my attempts to educate women that having a mastectomy won’t increase their odds of beating their cancer, they simply don’t believe me or the data. They have a mastectomy because they believe it is more likely to cure them than a lumpectomy. It helps them sleep better at night knowing the breast is gone.

Other women choose mastectomy because they want to try to avoid radiation. After lumpectomy, radiation therapy is almost always indicated. After mastectomy, it is possible that radiation will be needed, but it isn’t as common. Radiation can be time-consuming and require time away from work. Treatments are given daily, therefore women that live a long way from a radiation therapy center may choose mastectomy because daily travel would be difficult. Radiation also has potential side effects that should be considered when making a decision about which surgery to choose.

Some women choose mastectomy under the mistaken impression that it will make it less likely they will need chemotherapy. However, the type of surgery you choose has no impact on whether or not you will need chemo.

Finally, some women choose mastectomy because their plastic surgeon has promised them beautiful boobs and a tummy tuck as part of the reconstruction process. I mean who doesn’t want perky boobs and a flat stomach paid for by insurance? In all seriousness though, I really do see this in my practice as a reason that some women choose mastectomy and also why some women choose double mastectomy…so the reconstructed breasts match. After all, life will go on after cancer and these things do matter to some women.

There are also a few medical reasons that your doctor may recommend mastectomy. These include a very advanced tumor or a tumor that involves multiple areas of the breast, current pregnancy, or a history of prior radiation to the breast. In some cases of large tumors, the surgeon will recommend doing chemo first to shrink the tumor so that a lumpectomy is still possible.

Why choose lumpectomy?

The reasons women choose lumpectomy are more straightforward.

Most women that choose lumpectomy typically do so for one of two reasons:

They like the idea of a smaller surgery with less risk of complications and less recovery time.

They want to keep their breast.

So which surgery should you choose?

In my mind, the most compelling reason to undergo mastectomy is to avoid radiation if the idea of radiation scares you. Although the vast majority of my patients will tell you that radiation isn’t nearly as bad as they feared it would be.

The most compelling reason to choose lumpectomy (again, in my mind) is to preserve the natural breast. Preserving the breast may sound like a superficial reason to some, but the psychological effects of mastectomy can’t be understated. Depression, low self-esteem, and sexual aversion are all potential consequences that not many people talk about. For women that undergo reconstruction after mastectomy, a number of them are pleased, a number of them say that it just isn’t the same as their “real” breasts, and a number say that the procedure was so difficult and time-consuming that they wouldn’t do again.

Ultimately the decision is yours based on your priorities and concerns. You can’t make a wrong decision in terms of what is best for your cancer. Your cure rate is the same regardless of what surgery you choose!

As always, I’m here if you have any questions. Please do not hesitate to contact me or call my office for an appointment. I’m happy to help you in any way I can.