Health Library Should I Have Breast-Conserving Surgery or a Mastectomy to Treat Early-Stage Breast Cancer?From Healthwise

This information will help you understand your choices, whether you share in the decision-making process or rely on your doctor's recommendation.

Key points in making your decision

The two types of surgery to treat breast cancer are:

• Surgery to remove the breast (mastectomy).
• Surgery to remove just the area of the breast that contains cancer (breast-conserving surgery, or lumpectomy) followed by radiation treatments.

This is an overview of important issues to think about as you decide which type of surgery to have to treat stage I or II breast cancer. Facts about your breast cancer that may help guide your decision include:

• The size and location of your breast cancer. What your breast cancer looks like on the mammogram makes a difference.
  • If the tumor is small, removing it may leave only a small defect in the breast. Breast-conserving therapy would be a good choice in this situation.
  • If the tumor is at the edge of the breast, removing it may leave only a small defect in the breast. Breast-conserving therapy would be a good choice in this situation.
  • If you have two or more areas of cancer in the same breast that are too far apart to be removed with a single incision or if you have a precancerous condition called ductal carcinoma in situ (DCIS) throughout your breast, you may wish to have a mastectomy.
  • If the tumor is large in relation to the size of your breast, the surgeon may have to remove a lot of breast tissue to remove the cancer. In this case, you may not be satisfied with the way the breast looks. You may wish to have a mastectomy with reconstructive surgery to restore the appearance of the breast.
  • If the tumor is under the nipple and areola, removing it may leave a large defect in the center of the breast, and the nipple may also need to be removed. If this is the case, you may wish to have a mastectomy.
• Whether you have very large breasts. If you choose to have a mastectomy, you may have muscle strain or back and neck problems because of a weight imbalance. But some women with large breasts may choose to have a mastectomy and breast reconstruction and to have surgery to make the other breast smaller (reduction mammoplasty).
• Your feeling about keeping your breast. This is a very personal choice. Choose what feels right to you.
• Your feelings about the need for radiation therapy after breast-conserving surgery. Think about the distance you will have to travel for the treatment as well as additional time you may have to take from work versus a longer time off from work that may be needed to recover from a mastectomy.

What is breast cancer?

Breast cancer is a disease in which cells in the breast grow abnormally in an uncontrolled manner. It is highly curable if found early.¹

What types of surgery are used to treat breast cancer?

The two different types of surgery used to treat breast cancer are:

• Surgery to conserve the breast, combined with an exam of some of the lymph nodes under the arm (either axillary lymph node dissection or sentinel lymph node biopsy) and radiation therapy.
  • The removal of the lump in the breast and some of the tissue around it is called a lumpectomy. You may also hear the words "excisional biopsy" or "wide excision."
  • The removal of the area of the breast that contains cancer as well as some of the breast tissue around the tumor and the lining over the chest muscles below the tumor is called a partial or segmental mastectomy.
• Removal of the breast (mastectomy).
  • The removal of the entire breast is called a total or simple mastectomy.
  • The removal of the breast, the lymph nodes under the arm (axillary lymph nodes), the lining over the chest muscles, and sometimes part of the chest wall muscles is called a modified radical mastectomy.
  • The removal of the breast, chest muscles, and all of the lymph nodes under the arm is called a radical mastectomy. For many years, this was the most common operation for breast cancer. Many years ago it was called the Halsted radical mastectomy. Radical mastectomy is not used now, because it does not increase life span or decrease the chances that the cancer will come back any more than other surgeries. A radical mastectomy causes many more side effects than other surgeries.

What will help me decide which type of treatment to choose?

How far the cancer has spread within your breast and whether it has spread to nearby tissues or other organs is called the stage. Your doctor will determine the stage of your breast cancer by gathering information from other tests such as lymph node biopsies, blood tests, bone scans, and X-rays. The stage of your cancer is one of the most important factors in selecting the treatment option that is right for you.

Does one type of treatment work better than the other?

For many years experts thought that having a mastectomy would help you live longer and reduce the chance that your breast cancer would come back (recur). Studies now show that breast-conserving surgery followed by radiation therapy is as good as mastectomy in treating early-stage breast cancer.²

Why might my doctor recommend a mastectomy instead of a lumpectomy?

Your surgeon may encourage you to have a mastectomy if:

• You have two or more areas of breast cancer in the same breast that are too far apart to be removed with a single incision (cut). After the surgeon removes both areas and some normal tissue around them, you may not have much breast tissue left.
• You have precancerous changes in more than one-quarter of your breast (one breast quadrant) or throughout one or both breasts.
• Your breast cancer is large or is large relative to the size of your breast, and removing it will require removing a lot of breast tissue. You may not be satisfied with the way your breast looks after surgery.
• You have a serious lung disease, such as COPD or emphysema. The radiation therapy needed after a lumpectomy may make your lung problems worse.
• You have already had radiation treatment to your breast or your chest to treat another condition, such as Hodgkin's lymphoma.
• You have a connective tissue disease, such as scleroderma, that makes you especially sensitive to the effects of radiation.
• You are pregnant. Radiation treatment should not be used during pregnancy.

If you need more information, see the topic Breast Cancer.

Your choices are to have:

• Surgery to remove the breast (mastectomy).
• Surgery to remove just the cancer from the breast (breast-conserving surgery) followed by radiation treatments.

Let your personal feelings and the medical facts about your breast cancer guide your treatment choices.

These personal stories may help you make your decision.

Use this worksheet to help you make your decision. After completing it, you should have a better idea of how you feel about breast cancer surgery. Discuss the worksheet with your doctor.

Circle the answer that best applies to you.

*NA = Not applicable

Use the following space to list any other important concerns you have about this decision.

What is your overall impression?

Your answers in the above worksheet are meant to give you a general idea of where you stand on this decision. You may have one overriding reason to choose mastectomy or breast-conserving surgery.

Check the box below that represents your overall impression about your decision.

Return to the topic Breast Cancer.

Citations

1. Paley PJ (2001). Screening for the major malignancies affecting women: Current guidelines. American Journal of Obstetrics and Gynecology, 184(5): 1021–1030.

2. Davidson NE (2004). Breast cancer. In DC Dale, DD Federman, eds., ACP Medicine, section 12, chap. 7. New York: WebMD.

Author:	Kathe Gallagher, MSW	Last Updated: August 31, 2007
Medical Review:	Joy Melnikow, MD, MPH - Family Medicine Douglas A. Stewart, MD - Medical Oncology
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