Choosing between breast-conserving surgery and mastectomy

Choosing between breast-conserving surgery and mastectomy

Many women with early-stage cancers can choose between breast-conserving surgery and
mastectomy.
The main advantage of breast-conserving surgery (BCS) is that a woman keeps most of
her breast. A disadvantage is the usual need for radiation therapy—most often for 5 to 6
weeks—after surgery. A small number of women having breast-conserving surgery may
not need radiation while some women who have a mastectomy will still need radiation
therapy to the breast area.
When deciding between BCS and mastectomy, be sure to get all the facts. You may have
an initial gut preference for mastectomy as a way to "take it all out as quickly as
possible." This feeling can lead women to prefer mastectomy even when their surgeons
don’t. But the fact is that in most cases, mastectomy does not give you any better chance
of long-term survival or a better outcome from treatment. Studies following thousands of
women for more than 20 years show that when BCS can be done, doing mastectomy
instead does not provide any better chance of survival.

Most women and their doctors prefer BCS and radiation therapy when it's a reasonable
option, but your choice will depend on a number of factors, such as:
· How you feel about losing your breast
· How you feel about getting radiation therapy
· How far you would have to travel and how much time it would take to have radiation
therapy
· Whether you think you will want to have more surgery to reconstruct your breast after
having a mastectomy
· Your preference for mastectomy as a way to get rid of all your cancer as quickly as
possible
· Your fear of the cancer coming back
For some women, mastectomy may clearly be a better option. For example, breast
conserving surgery is usually not recommended for:
· Women who have already had radiation therapy to the affected breast
· Women with 2 or more areas of cancer in the same breast that are too far apart to be
removed through 1 surgical incision, while keeping the appearance of the breast
satisfactory
· Women whose initial BCS along with re-excision(s) has not completely removed the
cancer
· Women with certain serious connective tissue diseases such as scleroderma or lupus,
which may make them especially sensitive to the side effects of radiation therapy
· Pregnant women who would require radiation while still pregnant (risking harm to the
fetus)
· Women with large tumors (greater than 5 cm [2 inches] across) that didn't shrink very
much with neoadjuvant chemotherapy
· Women with inflammatory breast cancer
· Women with a cancer that is large relative to their breast size
Other factors may need to be taken into account as well. For example, young women with
breast cancer and a known BRCA mutation are at very high risk for a second cancer.
These women often consider having the other breast removed to reduce this risk, and so
may choose mastectomy for the breast with cancer as well. A double mastectomy may be
done to treat the cancer and reduce the risk of a second breast cancer.

It is important to understand that having a mastectomy instead of breast-conserving
surgery plus radiation only lowers your risk of developing a second breast cancer in the
same breast. It does not lower the chance of the cancer coming back in other parts of the
body. It is important that you don’t rush into making a decision, but instead take your
time deciding whether a mastectomy or breast-conserving surgery plus radiation is right
for you.