At The Johns Hopkins Hospital, patients receive their diagnosis from their radiologist and have some time before coming in to discuss treatment options with a surgical oncologist. Regardless of whether you choose to have a lumpectomy or mastectomy, the recurrence rate remains at approximately 10 percent in the treated breast and about 0.
The risk of getting a different cancer is about 2 percent. While a breast tumor is worrisome and will require treatment, it may not be fatal. The real risk to your life is if the cancer spreads to another part of the body, such as the lymph nodes, bones and lungs. Removing the entire breast does not affect the rate at which the disease spreads. A plastic surgeon can shed additional light on the cosmetic implications of the procedures based on the size of the tumor, your breast size, body type and long-term effects of radiation.
Regardless of our recommendation, some women who are eligible for a lumpectomy will still choose mastectomy or bilateral mastectomy removing both breasts because they have a genetic mutation that predisposes them to a second cancer in either the same or other breast.
By removing one or both breasts, they may reduce their chance of developing a second breast cancer. Some patients prefer preserving part of the breast with a lumpectomy over removing the breast with a mastectomy because that allows them to retain some sensation and function in the original breast. Even if a tumor is large enough that the patient needs reconstruction after a lumpectomy, she may still be able to retain most of her feeling in the breast.
For many women, preserving sensation in the breast is a major priority and one of the biggest reasons they choose a lumpectomy. In that procedure, known as oncoplastic surgery, the breast surgeon removes the tumor, and then the plastic surgeon may perform a breast reduction or fill the cavity with fatty tissue from another part of the breast.
This also allows the patient to complete radiation therapy with a mostly normal-shaped breast, helping her feel more like herself as she continues her treatment. Because the standard treatment for breast cancer with lumpectomy includes follow-up radiation therapy, some women who would be good candidates for a lumpectomy choose mastectomy in the hope of avoiding radiation therapy and its potential side effects.
Those may include:. The severity of these side effects varies widely from patient to patient. In many cases, additional surgeries may help improve the symmetry between the radiated and non-radiated breast. Women who undergo a mastectomy may be able to avoid radiation therapy and its potential side effects, as long as the cancer has not spread to surrounding tissue. In many cases, a mastectomy removes such a large margin of healthy tissue that radiation therapy may not be necessary. Radiation therapy after a mastectomy lowers that risk to about 6 percent.
Those who had one breast removed will only need mammograms on the unaffected breast. Those who undergo a bilateral mastectomy on both breasts will no longer require routine mammograms. Cancer may still recur on the skin or chest wall, but lumps or other signs of cancer may typically be identified with regular physical exams.
A mastectomy with reconstruction typically involves multiple surgeries, even if you opt for immediate reconstruction during the breast surgery. More surgeries mean more disruption to your everyday life, a longer recovery process and a higher risk of complications. These are important considerations to weigh when deciding whether to opt for a mastectomy.
Another disadvantage is the loss of sensation that usually comes with reconstruction after a mastectomy. Even if the patient is a good candidate for a nipple-sparing mastectomy or a skin-sparing mastectomy, removing the breast will cause at least some numbness. However, depending on the type of reconstruction the patient undergoes, her breast may still feel warm and soft to the touch. Emerging techniques using nerve grafts may help restore some breast sensation following mastectomy, but results are unpredictable and may take up to two years.
Breast reconstruction after a mastectomy typically involves more long-term maintenance than a lumpectomy, especially for patients who have reconstruction with breast implants instead of their own tissue. One would think most women would choose BCS as a less invasive and breast-conserving! Mastectomy used to be the routine surgical treatment for breast cancer, including early-stage cancer, up until the mids.
By the mids, BCS had become the predominant type of surgery for early breast cancer. Why did this dramatic shift take place? The reason is that multiple clinical studies showed that survival after either of two surgeries is very much the same, especially when BCS is followed by radiation treatment.
Published in , a year follow-up of women who had either BCS or mastectomy convincingly showed that overall survival after lumpectomy with radiation was equivalent to overall survival after mastectomy. Many studies have followed, reaching the same conclusion. The Susan G. Komen Foundation has compiled data from numerous trials comparing the two procedures, which clearly show no difference in overall survival after many years of follow-up.
With the recommendation of BCS in , the medical community was happy to be able to offer women both a less invasive and traumatic surgical option, and women, it seems, were happy to have this choice.
But fast-forward just about 10 years, and you will see that the trend was not there to stay.
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