In its simplest form, breast cancer is the uncontrolled growth of cells in the tissues of the breast. These malignant cells, which can spread from their origin throughout the entire body, grow and multiply in a disorderly fashion, leading to the growth of tumors. Breast cancer is the most common form of cancer women face, affecting one out of every eight women in their lifetime, and while it affects both men and women, it is far more common in women. It is estimated that nearly 200,000 women are diagnosed with breast cancer every year, and 40,000 of those diagnosed lose their life to the disease annually; on average, men are diagnosed with breast cancer at one-tenth that rate.
If you are diagnosed with breast cancer, it is very likely that surgery will play an integral role in your treatment plan, typically in combination with radiation and/or chemotherapy. When treating breast cancer surgically, there are two primary procedures that your provider will consider: mastectomy and lumpectomy. Each procedure carries with it its own list of advantages and disadvantages and, ultimately, your individual case and preferences will help inform which procedure is right for you.
A mastectomy is the surgical removal of the entire breast (mast-breast + ectomy-surgical removal). As such, it is a far more intense procedure and requires a longer recovery period than a lumpectomy. It also opens patients up to more serious surgical side-effects, such as complications from anesthesia and infection. Mastectomy results in the permanent loss of the entire breast and, while there are reconstructive procedures that can be done to regain the appearance of a breast, it is a physically and emotionally traumatic experience for many women. However, some women find great comfort in knowing that the entire breast, along with all of its cancerous tissue, has been removed, and that they will have to undergo less post-procedure radiation and chemotherapy to combat the disease.
A lumpectomy, often known as a breast-saving surgery, is a precision-driven procedure that allows for the surgical removal of the cancerous lump, while saving the majority of the breast. Because the procedure is less invasive, there is a greater chance that parts of the tumor could be left behind, requiring the use of more post-operative radiation, chemotherapy, and possibly even additional surgery if the pathology of the tissue around the lump contain cancerous cells. Regardless, many women opt for this procedure as it requires a shorter recuperation period and allows them to keep a greater portion of their own breast.
Which one is right for me?
There are a number of factors to consider when deciding which procedure to move forward with following a breast cancer diagnosis. Clinically speaking, mastectomy will be more effective at removing cancerous tissue in any given case because it takes far more breast tissue than a lumpectomy. However, lumpectomy paired with radiation can be equally as effective as mastectomy for tumors that are less than 4cm wide, are isolated to one site within the breast, and have clear margins, meaning there do not appear to be any cancerous cells in the healthy tissue surrounding the lump.
However, there is also a deeply personal angle to be considered when making this decision with your surgeon. Two of the most important questions to answer for yourself are how important is it for you to keep your breast and how concerned are you about the cancer returning. If keeping your breast is very important to you and you are comfortable assuming some of the risk involved with leaving tissue, then a lumpectomy could be right for you. Conversely, if you are fine with cosmetic reconstruction following surgery—or you don’t even want that—and your chief concern is removing as much potentially cancerous tissue as possible, then mastectomy will probably be the procedure you choose. In any case, the most important thing you can do is have an open and honest conversation with your surgeon about your priorities so that the two of you can make an informed decision together about how to move forward with your treatment.