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  • Dr Tarangini

Mastectomy vs Lumpectomy - What is right for you?

Breast cancer treatment:

Both breast mastectomy and lumpectomy are done to get rid of breast cancer. Both are effectual, but the benefits and risks are different. Lumpectomy safeguards the breast and mastectomy removes the breast.

Lumpectomy is a type of breast surgery to remove breast cancer while preserving the breast. Lumpectomy attempts to bring the breast as close to the original breast as possible. During this surgery, the doctor removes the tumour and the surrounding affected tissue. Other names related to this procedure are: Biopsy, Breast-conserving surgery, Re-excision.

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Radiation therapy (RT) may be needed after breast mass removal to prevent the cancer from recurring and destroying the remaining cancer cells. This procedure is advised for patients with less invasive cancer. If the cancer has spread to the entire breast or the tumour is too large, your doctor may recommend a mastectomy.

Mastectomy treats breast cancer by removing the entire breast.


Different Types of Mastectomy

Basic- The doctor removes the entire breast in this procedure, but not the lymph nodes in the forearm or the muscles under the breast.

Modified radical- In this procedure, the doctor removes the entire breast and some lymph nodes. However, the muscle is not removed.

Radical-This is the most invasive type of mastectomy. In this method; the doctor removes the entire breast, lymph nodes in the forearm, and chest muscles.

Partial- The doctor removes the part of the breast that has been affected by the cancer and the surrounding tissue in this procedure. This procedure is similar to lumpectomy, but more tissue is removed.

Subcutaneous- This surgery, also known as nipple-preserving mastectomy, removes all breast tissue but protects the nipple.


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Advantages of Lumpectomy

Some patients choose preserving part of the breast with a lumpectomy over removing the breast with a mastectomy because that lets them to retain some sensation and function in the original breast.

It`s sometimes possible to maintain lactation after a lumpectomy—which is impossible with a mastectomy.

When a tumour is minor to be removed without deforming the breast, surgical oncologists typically recommend a lumpectomy because it`s less invasive, doesn`t entail as much surgical intervention, tends to have a faster recovery and is generally less risky.

The normal treatment for breast cancer with lumpectomy includes follow-up radiation therapy, some women who would be good candidates for a lumpectomy prefer mastectomy in the hope of avoiding radiation therapy.

Physical changes to the skin and breast tissues, making the skin thicker and less stretchy, darkening of the skin, swelling in the skin (breast lymphedema) which makes the breast larger,

Disadvantage of lumpectomy

It has a slightly higher chance of recurrence.

Studies have shown that the survival rate of women who had a lumpectomy is similar to that of women who had a mastectomy,

The chances of local cancer recurrence from lumpectomy are slightly higher in patients. It turned out to be about 15% in a patient’s lifetime, compared to 6 percent of patients with mastectomy.

The total cost of a lumpectomy is notably higher than that of a mastectomy.

Advantages of Mastectomy

Women undergoing mastectomy may be able to avoid radiation therapy and its potential side effects unless the cancer has spread to surrounding tissues.

In many cases, mastectomy removes a very large edge of healthy tissue, so radiation therapy may not be needed. However, some women need radiation therapy even after a mastectomy without a clear margin (that is, pathologists cannot find cancer cells in the healthy tissue around the tumour).

If the cancer has spread to the lymph nodes in the armpit, the patient has an approximately 23% chance of recurrence of the local cancer within 5 years. Radiation therapy after mastectomy reduces this risk to about 6 percent.

Disadvantages of mastectomy:

A mastectomy with reconstruction usually involves multiple surgeries, even if you decide to reconstruct immediately during the breast surgery.

Breast reconstruction after mastectomy usually requires longer storage than breast augmentation, especially in patients who reconstruct using breast augmentation surgery instead of their own tissue.

Breast augmentation surgery usually needs to be replaced after about 10 years and may require further surgery to maintain symmetry between the reconstructed breast and the natural breast.

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Which procedure is right for you?

Deciding which surgery to perform is an important decision. Make sure to discuss your options with your doctor. Get a second opinion and don't be frightened about doing your own research.


With research and expert guidance, you can play an active role in your treatment by deciding which procedure is best for you.

When choosing between lumpectomy and mastectomy, it is important to consider the factors that are important to you. You may need to discuss several times with your cancer specialist or loved one to understand what you expect from each step and to set your personal priorities. Never hesitate to ask as many questions as you need until you are happy with your decision.

 

References

  1. Palit, Tapash & Miltenburg, Darlene & Brunicardi, Francis. (2000). Cost analysis of breast conservation surgery compared with modified radical mastectomy with and without reconstruction. American journal of surgery. 179. 441-5. DOI: 10.1016/S0002-9610(00)00383-4.

  2. Norum J, Wist E. Brystkreft behandlet ved Kreftavdelingen, Regionsykehuset i Tromsø 1986-94 [Breast cancer treated at the oncologic department, University Hospital in Tromsø 1986-94]. Tidsskr Nor Laegeforen. 1997 Oct 30;117(26):3786-9. Norwegian. [PubMed]

  3. Warren JL, Brown ML, Fay MP, Schussler N, Potosky AL, Riley GF. Costs of Treatment for Elderly Women With Early-Stage Breast Cancer in Fee-for-Service Settings .J Clin Oncol. 2002 Jan 1;20(1):307-16. DOI: 10.1200/JCO.2002.20.1.307

  4. Wang SE, Sun YD, Zhao SJ, Wei F, Yang G. Breast conserving surgery (BCS) with adjuvant radiation therapy showed improved prognosis compared with mastectomy for early staged triple negative breast cancer patients. Math Biosci Eng. 2019 Sep 26;17(1):92-104. DOI: 10.3934/mbe.2020005.

  5. Norum J, Olsen JA, Wist EA. Lumpectomy or mastectomy? Is breast conserving surgery too expensive?. Breast Cancer Res Treat. 1997 Aug;45(1):7-14. doi: 10.1023/a:1005804101106

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