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Lumpectomy or Mastectomy? Here’s What to Consider If You Have Breast Cancer

If you’re diagnosed with breast cancer, you and your doctor will talk through the various treatment options you should consider. While breast cancer diagnoses and treatment plans are different for every woman, often, you may have a choice when it comes to surgery. Two main options are:

  • Breast-conserving surgery often called lumpectomy, where a surgeon removes the tumor and a small margin of healthy breast tissue around it
  • Mastectomy, or surgery to remove the entire breast

A lot of people believe that mastectomy is the safer option — they think that removing the entire breast reduces the likelihood of breast cancer recurring. But that’s not necessarily true, said Kelsey Shay, MD, a breast cancer surgeon at Banner MD Anderson Cancer Center at Northern Colorado Medical Center. “With a few exceptions, breast-conserving surgery is just as safe.”

Dr. Shay filled us in on the pros and cons of both types of surgery.

Here’s what to know about choosing breast-conserving surgery

Dr. Shay said that some of latest research shows a slightly higher survival rate with breast-conserving surgery compared to mastectomy. Plus, with breast-conserving surgery, you’ll keep as much of your breast as possible. So, it can help with your body image and self-esteem. 

In some cases, if you want breast-conserving surgery and have a large tumor, you can have chemotherapy first to shrink the tumor, followed by surgery.

And sometimes, oncoplastic surgery is an option. That’s where a surgeon removes the lump and performs breast reconstruction surgery in the same procedure, often with a breast reduction or lift. Your surgeon may also modify your other breast at the same time, so your breasts are symmetrical. “It’s one of my most fulfilling moments as a breast surgeon when I can do oncoplastic surgery on a woman who desires breast conservation,” Dr. Shay said.

It’s important to remember that if you have breast-conserving surgery, you’ll most likely have radiation therapy afterward. And you’ll need screening mammograms and/or possibly breast MRIs. 

Dr. Shay encourages her patients to consider breast-conserving surgery. “I’m pro-breast conservation if it’s feasible and safe. It maintains the anatomy, and helps you avoid implants, which can have issues with scarring and leaking,” Dr. Shay said. “I don’t agree that you get peace of mind with a mastectomy because you can still get breast cancer.”

She worries about the trend of women, especially younger women, choosing double mastectomy. “I don’t think women are being appropriately educated. They think it’s safer, but that’s not what the research and data are showing. The American Society of Breast Surgeons is stressing to its members the importance of educating people on actual data,” she said.

Here’s what to know about choosing mastectomy

If you have inflammatory breast cancer or certain genetic mutations, mastectomy is probably the better choice. And, if you have a large tumor in a small breast, you might have a better cosmetic appearance with a mastectomy. 

After surgery, you may lose sensation in your nipple, even if you have nipple-sparing mastectomy. There’s a higher chance of nerve pain, numbness or issues with scar tissue compared to breast-conserving surgery. And you may need multiple surgeries after mastectomy to reconstruct your breast.

Most women don’t need radiation after a mastectomy. And you may no longer need mammograms, depending on what type of reconstruction you have following mastectomy.

If you’re deciding what type of surgery to have for breast cancer, Dr. Shay recommends thinking about your goals. Some women make their treatment and surgical option decisions based on the desire to avoid needing mammograms in the future.  For others, maintaining their appearance is more important, so they choose breast-conserving surgery.

The importance of mammograms

When talking about breast cancer, Dr. Shay wanted to remind all women to stay on schedule with their mammograms. That way, you increase your odds of finding any breast cancer early, when it may be easier to treat. “There’s a lot of controversy on how often you should have mammograms. I’m a strong believer in having them every year starting at age 40. I don’t recommend alternating or starting at 50. And some patients are told to stop at age 70. That’s something you should discuss with your doctor. Healthy 70-year-olds should still have mammograms — they might live to be 100,” she said.

The bottom line

If you are diagnosed with breast cancer, you may be able to choose the type of surgery you can have. Make sure you have all the information about the pros and cons of mastectomy and breast-conserving surgery so you can make an informed decision. To connect with a Banner MD Anderson health care provider who can talk to you about breast cancer treatment options, visit bannerhealth.com.

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