By Jennifer McAlister, MD, FACS
One of the most difficult decisions a woman will make regarding a diagnosis of breast cancer is deciding which type of surgery to pursue. In early stage breast cancer, meaning a relatively small tumor and minimal or no lymph node involvement, women are often given a choice regarding two procedures, mastectomy or lumpectomy. Understanding the differences between the two can make a difference in your decision.
Some points to keep in mind:
- Regardless of surgery type, lymph nodes may be checked in invasive breast cancers.
- Regardless of surgical choice, the need for systemic treatments such as chemotherapy and hormonal therapy is a separate decision.
- Perhaps the biggest point to consider, regardless of surgical type, for early breast cancers, the survival rate at ten years post operation is equal.
A lumpectomy, or partial mastectomy, means that part of the breast is removed. Essential to a lumpectomy being successful is margins. Margins are the amount of normal breast tissue surrounding the tumor when it is removed. Margins are referred to as clear, clean, good or negative if they are adequate. Margins do not need to be large, in fact, depending on the cancer type, there just needs to be no tumor present at the margin. If margins are clear, then a patient should plan on radiation treatment. This is the standard of care for most patients and breast cancers after lumpectomy. There are some patients in whom radiation may not be necessary. That is usually determined once surgery is complete. If margins are not clear (this can happen up to 15-20% of the time with lumpectomy), patients will require a re-excision. A re-excision means that a little more tissue is surgically removed to obtain negative margins.
A mastectomy means that the entire breast is removed and margins are typically not an issue with this procedure. What’s more, radiation is not typically required after a mastectomy, with exception of a few circumstances. For those who choose to do so, following a mastectomy, breast reconstruction can take place, but may require additional surgeries. It’s also important to note that having both breasts removed does not increase survival from cancer, though it does increase surgical risk of complications.