Most cancers that are still small and unlikely to have spread out of the breast can be treated with lumpectomy or partial mastectomy. This option is commonly referred to as ‘breast conserving therapy’, because most of the normal breast tissue remains intact.
Given the choice, the decision of whether a woman undergoes a mastectomy or breast conserving therapy is entirely up to her. You should discuss the pros and cons of each method with your surgeon. However, several important points need to be emphasized when contemplating this decision:
- Lumpectomy offers the best cosmetic outcome available for the treatment of breast cancer. In most cases, the scar from surgery can be easily hidden in a bra, and the bust remains full. The nipple and the sensation around it will also remain. Finally, the woman does not go through the shock of losing her breast.
- After a lumpectomy, most women will have to undergo radiation therapy. Radiation is designed to ‘kill’ cancer cells that may be remaining in the breast, and thus decrease the likelihood that the cancer would come back in the breast after treatment (so-called local recurrence).
- Radiation does not completely eliminate the risk that the cancer would come back. In fact, the risk of local recurrence after breast conserving therapy even with radiation remains higher than the risk of recurrence after mastectomy.
- Radiation will increase the time required to treat the cancer, and is not without its risks.
- Mastectomy offers the smallest chance that the cancer would come back in the breast but it does not completely eliminate this risk.
- Women who undergo a mastectomy rarely require radiation therapy.
- Some women with a very large cancer or many axillary lymph nodes that are positive may need to have radiation therapy after a mastectomy.
However, a mastectomy is strongly recommended when:
- The cancer is large or found in more than one part of the breast, so-called multicentric disease.
- The breast is small or shaped so that a lumpectomy would leave little breast tissue or a very deformed breast.
- A woman chooses not to have radiation therapy.
- A woman prefers a mastectomy.
