HealthONE - June 13, 2019

For women who have completed a breast biopsy and been diagnosed with breast cancer, a surgeon will often present them with two treatment options: a lumpectomy or a mastectomy. Women recently diagnosed with breast cancer might ask: what is the difference between the two?

Lumpectomy vs. mastectomy

A lumpectomy is viewed as breast-conserving surgery. The goal of a lumpectomy procedure is to remove the cancer and some of the surrounding normal breast tissue but leave the breast intact.

A mastectomy, on the other hand, removes the entire breast. There are several types of mastectomy, including a simple mastectomy, a modified radical mastectomy, a nipple-sparing mastectomy and a skin-sparing mastectomy, with the latter two being the most commonly used mastectomy surgeries. A patient having a mastectomy also may choose to have reconstructive surgery following mastectomy (as opposed to a simple mastectomy, where reconstruction is not undertaken).

If a woman is having a procedure with reconstruction, she will see a breast reconstruction specialist (often called a plastic surgeon) prior to her surgical procedure. These are women who are undergoing breast reconstruction after a mastectomy or in combination with a reduction lumpectomy (a lumpectomy where a breast reduction is done at the time of lumpectomy surgery).

"Many advancements have been made in the field of breast surgery," explains Stephanie Miller, MD, breast cancer surgeon with Colorado Total Breast Health at Rose Medical Center. "If a patient needs to undergo a mastectomy, she might be eligible for options that preserve the nipple and areola or the breast skin. These techniques help enhance breast reconstruction after the cancer is treated, which retains a more natural look and allows women to feel more like themselves."

Axillary lymph nodes

Removal of lymph nodes is a separate part of the breast cancer surgical operation used in the treatment of breast cancer. The removal of lymph nodes is commonly done by a careful identification process known as sentinel lymph node dissection. The results of the lymph node evaluation do not change the surgical treatment plan for the breast.

Other breast cancer treatments needed before or after surgery

Before surgery, a breast cancer patient may undergo chemotherapy to shrink the size of the tumor and reduce the amount of tissue that needs to be removed. After surgery, women may need to undergo radiation therapy, chemotherapy, targeted therapy or endocrine therapy to destroy any remaining cancer cells. Treatments plans are individually determined based on a woman's diagnosis and collaboration with the patient and her care team.

Choosing the right breast cancer surgery option for you

For women diagnosed with breast cancer, a lumpectomy is often a good surgical option if the cancer is in an early stage and limited to a specific area of the breast. There are cases when chemotherapy prior to surgery can decrease the size of the cancer and allow a woman to consider a lumpectomy, even if she originally had not been a candidate for lumpectomy. Most patients who undergo a lumpectomy also receive radiation therapy afterward.

On the other hand, a surgeon may recommend a mastectomy if:

  • The tumor has spread throughout the entire breast, or encompasses the majority of the breast
  • A woman has multiple tumors in different areas of the breast, known as multi-centric tumors
  • A woman has inflammatory breast cancer
  • A woman has previously had high-dose radiation therapy to the affected breast

In some cases, a mastectomy may be a more appropriate choice for women experiencing certain psychosocial situations. For example, if the stress of preserving the breast and anxiety over breast cancer is severely emotionally debilitating, or if a woman has a genetic mutation that significantly increases her risk of a second breast cancer, then a mastectomy may be the right course of action. There are occasions when a woman may choose a mastectomy to avoid undergoing radiation therapy for a variety of personal reasons. Women should discuss concerns with the surgeon and the care team.

Most often, women have the choice between the two surgical options with equivalent outcomes and survival.

"Our goal is to work with each patient to determine the best treatment plan for their medical and psychological needs," Dr. Miller explains. "Each patient is a member of her medical team; we value her input and wishes as we create an individualized treatment plan."

If you or a loved one was recently diagnosed with breast cancer, talk to a doctor about the treatment options that might be best.

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