Submitted by Twin City Plastic Surgery
There is nothing easy or simple about a cancer diagnosis. From the moment a patient hears the words “you have breast cancer,” she begins an exhausting schedule of medical appointments, treatments, and procedures. While much attention is given to treating the patient’s medical condition, she also needs support in thinking through her options impacting her health and appearance.
The vast majority of breast cancer diagnoses involve some type of surgical treatment with lumpectomies being more common in early-stage cancer situations. According to the American Cancer Society (ACS), 57 percent of women with early stage (Stage I or II) breast cancer have a lumpectomy or partial mastectomy and 36 percent have a full mastectomy, with others electing non-surgical options. Thirteen percent of women with late stage breast cancer (Stage III or IV) have a lumpectomy or partial mastectomy and 60 percent have a mastectomy.
The ACS also tells us 20 to 40 percent of women who undergo mastectomy have breast reconstruction which typically includes an implant, tissue from another part of the body, or a combination of the two. Some types of reconstruction can begin during the mastecomy surgery itself, so having a reconstruction plan from the beginning of treatment is critical. Of course, some women are not candidates for lumpectomies due to the size or location of the tumor. But for a woman who has options, how does she make the decision to remove part or all of her breast?
Current data shows the type of surgery – lumpectomy or mastectomy – does not appear to impact a patient’s survival rate or possibility of cancer recurrence. Also, these surgical options do not impact the need and/or type of chemotherapy and/or hormone therapy a doctor recommends.
A lumpectomy always:
- Allows the patient to preserve more of their breast, which can give the patient comfort and an obvious feeling of normalcy.
- Involves a less extensive surgery in which the patient can go home the same day.
- Requires radiation as part of the therapy to treat the breast cancer.
- Does not involve placement of an implant.
Lumpectomy with radiation therapy (XRT) is becoming much more common versus a full mastectomy, and, therefore, mastectomies may be on the decline. From a breast conservation perspective and oncologic perspective, this is good. But there are some downsides to choosing lumpectomy/XRT that are rarely mentioned to the patient.
- Lumpectomies can result in uneven breasts which may not give the patient the look they hoped for.
- The defect may still leave a significant cosmetic concern, but any surgery to correct this may be considered cosmetic and be more difficult to get covered by insurance.
- Radiation treatments can cause adverse cosmetic changes such as darkening of the skin at the treatment site.
- Any surgery that is ever done on the radiated breast for the rest of that patient’s life, is at a much higher risk for complications due to the radiation, and, therefore, limits the patient’s options for reconstructive surgery in the future.
The decision to have a lumpectomy or mastectomy is as individual and personal as a surgery can be. Each patient should to talk with their plastic surgeon prior to making their final decision so they can be fully informed of the advantages and challenges of each option. As board-certified plastic surgeons, we have the education and experience to provide effective breast reconstruction consultations and provide our patients peace of mind during a stressful time as they reclaim their life and body from this disease.