Should You Have a Mastectomy or a Lumpectomy?

A growing number of breast cancer patients are opting for the bigger surgery—but is it necessary?

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Often, when it comes to breast cancer treatment, the goal for both women and their doctors is to save as much of the breast as possible, while still ensuring the best outcome for you as the patient.

This usually means lumpectomy—a surgery that involves removing the tumor and some surrounding tissue, while sparing most of the breast. 

Recently though, an increasing number of women are opting for mastectomy—a bigger surgery that can involve removing the entire breast, nipple, areola and sometimes lymph nodes.

This could be because many women think it’s the best way to ensure they get well. But according to some research, having a mastectomy may not guarantee a better outcome.

Is saving the breast a better bet for women? 

It’s generally accepted that mastectomies and lumpectomies, which are often followed by radiation, are about equally effective treatments for many cases of early-stage breast cancer. One 2019 analysis of about 845,000 breast cancer patients, for example, suggested their overall survival rates are similar. However, some studies have suggested lumpectomies yield better outcomes. 

In a study released in 2015, Dutch researchers found that nearly 77 percent of women with early-stage breast cancer who had a lumpectomy with radiation survived at least 10 years. But the women who opted for mastectomy had a 10-year survival rate of just under 60 percent. 

Researchers at Duke Cancer Institute found similar results in 2013. They looked at over 112,000 women who developed stage I or II breast cancer in a 14-year period, and found that those who went with lumpectomy and radiation had better outcomes than those who underwent mastectomies, across all age groups and tumor types.

Neither study was able to decipher exactly why women chose one treatment option over the other, or why lumpectomy appeared to have better results. But surgeon Barbara Schwartzberg, MD, of Rose Medical Center in Denver, Colorado, who was not involved in the studies, thinks that radiation may have played a key role.

“I think it really demonstrates how valuable radiation is,” she says.

In nearly all cases, and specifically at the time of these studies, radiation was required after the lumpectomy to “mop up” any remaining bits of cancer, says Dr. Schwartzberg, unlike mastectomy, which typically doesn’t involve any radiation at all for early-stage cancers.

Making the best call for your breast cancer 

Studies aside, deciding how to treat your breast cancer is deeply personal. 

In general, doctors will recommend a lumpectomy for women with smaller tumors who haven’t already had radiation, and for women who want to save as much of their breasts as possible. Breast-conserving surgery does require five to seven weeks of radiation, and you may have to wait to have reconstructive surgery. Schwartzberg notes, however, that the majority of women who undergo lumpectomies don't get delayed reconstruction, thanks to newer oncoplastic procedures. 

Since more breast tissue remains, the risk of growing another cancer is also slightly higher with lumpectomy.

Doctors generally recommend mastectomies for women with larger tumors, those who have already had radiation, who have multiple tumors in different areas of the breast or for women with a strong family history or the BRCA gene. Mastectomies are more convenient in certain ways, because reconstruction can be done at the time of the surgery and is paid for by insurance.

Another benefit, says Schwartzberg, is more peace of mind.

“We see patients who were cured of their original cancer with a lumpectomy and whole-breast radiation 20 years ago that are coming back with another cancer,” she says. “They don’t want that constant gun to their head for the rest of their lives.”

Whichever option you choose, Schwartzberg recommends educating yourself first.

“There are so many options for treatment. It’s important to make sure that you understand not only what you’ve chosen in terms of your surgery, but also how the doctor is going to evaluate you for chemotherapy, endocrine therapy and what the radiation oncologist can offer you."

Most importantly, she says, "you should take your time in making the decision about what’s right for you.”

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