Lumpectomy vs. mastectomy: Choosing the best

Many women with early-stage breast cancer can choose between a lumpectomy, which preserves the breast, and a mastectomy, which removes the entire breast. They will also need to be treated with radiation.

In most cases, a lumpectomy followed by radiation therapy has a comparable long-term survival rate as a mastectomy.

Many personal and medical considerations go into deciding between the two treatments, including the person’s medical history and worries about recurrence and cosmetic problems.

We go through lumpectomies and mastectomies in greater depth in this article, including what they entail and the possibility of recurrence. We also go through some of the advantages and disadvantages of each option, as well as other breast cancer care options.

Definitions

Doctor and her patient

Lumpectomies and mastectomies are similar procedures, but the medications and recovery times are different.

Mastectomy

A surgeon will remove the whole breast during a mastectomy.

Mastectomies come in a variety of forms. The American Cancer Society lists the following as examples:

  • Simple or total mastectomy: The entire breast, including the skin, areola, and nipple, is removed by the surgeon. Any lymph nodes under the arms can also be removed. The majority of patients are able to return home the same day as their surgery.
  • Skin-sparing mastectomy: Just the breast tissue, nipple, and areola will be removed, leaving the majority of the skin over the breast intact. The same amount of tissue will be removed as in a clear or complete mastectomy. The surgeon will then repair the breast using tissue from other parts of the body or implants.
  • Nipple-sparing mastectomy: The breast tissue is removed, but the skin and nipple are left intact. They can examine the breast tissue beneath the nipple for cancer cells. If cancer cells are discovered, the nipple will be removed as well.
  • Modified radical mastectomy: As with a simple or complete mastectomy, this operation entails the removal of the entire breast. The lymph nodes under the arms would also be removed by the surgeon.
  • Radical mastectomy: The surgeon removes the entire breast, the lymph nodes under the shoulder, and the pectoral muscles under the breast during this procedure. Surgeons also prescribe less invasive procedures that are equally successful but with less side effects. People with large tumours developing into the pectoral muscles, however, may still be candidates for this surgery.
  • Double mastectomy: Surgeons may perform this procedure, in which both breasts are removed, as a risk-reduction measure for people who are at a very high risk of breast cancer. The majority of double mastectomies are simple or complete, but some are nipple-sparing.

Lumpectomy

A surgeon will remove the breast tumour as well as some of the healthy tissue surrounding it during a lumpectomy. Since half of the breast is removed during a lumpectomy, it is considered a partial mastectomy.

The amount of breast tissue removed by the surgeon is determined by many factors, including the tumor’s size and position, as well as the breast’s size.

A quadrantectomy, for example, is a form of lumpectomy in which the surgeon removes approximately one-quarter of the breast.

Following a lumpectomy, a person would almost certainly need radiation therapy, as well as other treatments such as chemotherapy or hormone therapy.

Scarring or dimpling in the region where the tumour was before it was removed may occur after a lumpectomy. It may also cause pain and lymphedema, which is a form of swelling in the arm region. Following the operation, some patients want to undergo reconstructive surgery.

Factors to consider

Many women with breast cancer who have a choice of treatment prefer a lumpectomy over a mastectomy. Anyone who wants to make a decision should think about a number of things.

  • Maintaining the breast: A lumpectomy with radiation is an option for anyone who wants to hold their breast.
  • Lower risk of recurrence: A mastectomy is an option for anyone who is concerned about breast cancer returning. A lumpectomy carries a greater risk of local recurrence than a mastectomy.
  • Lower cost: If the cost of treatment is a problem, a lumpectomy could be the best option. According to a 2016 report, a mastectomy with reconstruction is significantly more costly than other alternatives.
  • Cosmetic factors: A lumpectomy may be preferable for people who want their breasts to fit as closely as possible, as this operation typically produces a good cosmetic result. Both lumpectomies and mastectomies, however, normally allow for reconstructive surgery.

A lumpectomy is not appropriate for anyone with breast cancer. An individual should consult with their doctor to see if a lumpectomy is a viable option for them.

Pros and Cons of Lumpectomy

To treat early, localised, or operable breast cancer, a surgeon can recommend a lumpectomy.

Other therapies, such as radiation therapy, chemotherapy, and hormonal therapy, may be needed.

The following are some of the pros and cons of lumpectomy:

Lumpectomy pros

  • Surgeons will be able to keep the breast’s appearance while still preserving the majority of the sensation.
  • People heal more rapidly and safely because the procedure is less invasive.
  • It is less expensive than a mastectomy.

Lumpectomy cons

  • Following a lumpectomy, patients are likely to undergo 5–7 weeks of radiation therapy.
  • The timing of reconstruction and the choices available can be affected if an individual requires radiation therapy.
  • People who want a lumpectomy over a mastectomy have a higher chance of local recurrence.
  • If a recurrence occurs, the breast will be unable to handle further radiation treatment, and the healthcare staff will most likely prescribe a mastectomy.
  • More surgeries will be needed if doctors discover more cancer cells in the breast after the initial surgery.

Pros and Cons of mastectomy

Mastectomy pros and cons include:

Mastectomy pros

  • Removing the whole breast and cancer site can be reassuring.
  • In comparison to a lumpectomy, radiation therapy is less likely to be needed.
  • As compared to a lumpectomy, there is a lower risk of recurrence.
  • If a person chooses not to have their breasts reconstructed, they are less likely to need additional surgery.

Mastectomy cons

  • Mastectomies are more involved than lumpectomies in terms of procedure.
  • The recovery time is longer, and a person may experience more side effects as a result of the surgery.
  • The irreversible loss of a breast may be upsetting to some people.
  • Additional surgery would be needed if the individual wishes to have reconstruction.

Some other treatment option

Other therapies for breast cancer may be provided before, after, or in addition to surgery. There are several treatment services available, including:

Radiation therapy

Radiation therapy kills cancer cells and stops them from developing by using X-rays or other forms of radiation.

Radiation therapy is divided into two types:

External beam radiation therapy

This treatment is used to treat breast cancer by doctors. Radiation is directed into the cancerous region by a machine outside the body.

Internal beam radiation therapy

This procedure, also known as brachytherapy, is used by doctors to alleviate bone pain caused by breast cancer that has spread to the bones. A material called strontium-89 is injected into a vein and passes to the surface of the bones. Radiation is released by the material, which destroys cancer cells in the bones.

Chemotherapy

Chemotherapy is a treatment that involves injecting drugs into a vein or muscle. Chemotherapy medications can also be taken orally.

When the drugs reach the bloodstream, they find and destroy cancer cells all over the body.

Hormone therapy

This procedure inhibits the growth of cancer cells by removing or preventing hormones from acting.

Doctors may search for hormone receptors on cancer cells in a sample of breast tissue. If these receptors are present, doctors may minimise or stop the development of hormones using surgery, radiation therapy, or medications.

Doctors may use ovarian ablation to prevent the ovaries from releasing oestrogen, the hormone that causes breast cancer to spread.

Targeted therapy

To recognise and attack individual cancer cells, doctors use targeted therapy.

Targeted treatments, unlike other therapies like radiation and chemotherapy, can be less detrimental to normal cells. As a result, they can cause less side effects in some situations.

This treatment can be provided by doctors in the form of medications.

Immunotherapy

Immunotherapy is a cancer treatment that makes use of the patient’s own immune system. It’s a kind of biological treatment.

Immunotherapy is a form of cancer treatment that uses synthetic or natural substances to guide, restore, or improve the body’s natural defences against cancer.

Conclusion

In the early stages of breast cancer, lumpectomies and mastectomies are also successful treatment choices. Personal interests and medical history, as well as the form of breast cancer, all play a role in a person’s decision.

Both options have benefits and drawbacks. Some people opt for a lumpectomy to keep their breasts looking natural, save money, or prevent more invasive surgery.

Others can opt for a mastectomy to gain peace of mind, reduce the need for radiation therapy, or reduce the risk of recurrence.

Other treatment options are available, which can be used before, after, or in conjunction with surgery. Radiation therapy, chemotherapy, hormone therapy, targeted therapy, and immunotherapy are some of the choices available.

Sources

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