Women who need surgery may be a candidate for either a lumpectomy (removal of the tumor and surrounding tissue) or a mastectomy (total removal of one or both breasts). Women may also choose to have reconstructive surgery after lumpectomy or mastectomy.
A lumpectomy (also called a partial mastectomy) is considered “breast-conserving” surgery because only the tumor and a surrounding area of normal breast tissue (called the margin) is removed. Lumpectomy is usually followed by a course of radiation therapy to make sure that any remaining cancer cells in the breast have been killed.
Your best surgical treatment comes about after a lengthy and detailed discussion with your doctor. Your lifestyle, preferences and psychological outlook should all be taken into consideration.
For lumpectomy, an estimated 50 percent of women with breast cancer are good candidates. Lumpectomy is an attractive surgical option because it is both extremely effective and also allows a woman to keep her breast. Studies show that women have an equal chance of surviving breast cancer whether they have a lumpectomy followed by radiation therapy or they have a mastectomy. With a lumpectomy, however, there is a slightly higher chance that the cancer can come back within the breast. This is called a local recurrence.
The location, size and type of tumor as well as the size of the patient’s breast are all important considerations when choosing a surgical option. Lumpectomy (breast-conserving surgery) may not be the best choice when:
- The tumor is too large
- The tumor is located in an area where it is difficult to remove with good cosmetic results
- Two or more areas of cancer are found in one breast. This is called multifocal or multicentric disease. The tumor cannot be removed as a single lump so a mastectomy is required.
A single large or hard-to-access tumor may be treatable with chemotherapy or endocrine therapy prior to surgery in an attempt to decrease its size. This allows the surgeon to remove a much smaller amount of tissue during the lumpectomy.
Since radiation therapy is an important part of breast conservation, women who are not good candidates for post-operative radiation typically cannot undergo a lumpectomy. Women with the following conditions are generally advised not to consider lumpectomy:
- Women with prior radiation treatment to breast or chest area
- Women with connective tissue diseases such as scleroderma
- Women who are pregnant at the time of radiation therapy
The outer edges of the removed breast tissue are tested. If they contain cancer cells (called a positive margin), additional surgery (re-excision) is usually recommended to remove the remaining cancer. If it is not possible to clear the margins with re-excision(s), a mastectomy is usually necessary for successful treatment.
Mastectomy is surgery to remove one or both breasts. Different types of mastectomy are performed depending on the amount of breast tissue that must be removed or whether lymph nodes and the nipple are removed.
Mastectomy does not require radiation therapy following surgery and may be a better choice than lumpectomy when:
- The tumor is larger than 5 centimeters
- A woman’s breast is small and a lumpectomy would be disfiguring
- A previous lumpectomy has been unsuccessful in removing the cancer
- Other health conditions mean mastectomy is the best choice
- Removing the entire breast offers peace of mind that the cancer is gone
Making a decision between lumpectomy and mastectomy can be very difficult for women. There are benefits and risks to both. Your physician is your best resource as you consider your options.
Some women choose to have reconstructive surgery on their breast. Reconstructive surgery may be done immediately following lumpectomy or mastectomy. Sometimes women have the surgery later. Others choose not to have any form of reconstruction.
Inova offers a number of breast reconstruction options, each designed to restore the removed breast tissue with an alternate that resembles the anatomic form and characteristics of a normal breast. Among the procedures offered at Inova are the TRAM flap procedure, which uses tissue from the abdomen to reconstruct the breast, as well as the newer DIEP flap and SIEA flap procedures. The flap procedures spare abdominal muscle tissue, resulting in decreased post-operative pain, less long term abdominal weakness and a decreased chance of post-surgical hernia formation. Breast implants are another option.