Breast cancer, a prevalent malignancy among women worldwide, necessitates various surgical interventions as part of its treatment. Two primary surgical options are lumpectomy and mastectomy. This guide aims to provide an in-depth understanding of both procedures, elucidating their benefits, risks, and the factors influencing the choice between them.
Lumpectomy
A lumpectomy, often termed breast-conserving surgery. involves the surgical removal of the tumour and a small margin of surrounding healthy tissue. This procedure is typically recommended when the cancer is detected early and is confined to a small area.
Benefits
- Less invasive: Lumpectomy requires smaller incisions compared to a mastectomy, leading to quicker recovery.
- Preserves the natural shape of the breast: As only a portion of the breast tissue is removed, the breast retains much of its natural shape and appearance.
- Often a same-day procedure: Many patients can return home the same day after undergoing a lumpectomy.
Risks and considerations
- Potential need for second operation: Although all efforts are made to ensure all the cancer is removed during the first operation, there is a small percentage of patients who will need a second operation to remove more tissue as some cancer may not be detected on pre-operative imaging and intra-operative testing.
- Definite need for radiation therapy: Post-lumpectomy, patients must undergo radiation therapy to reduce the risk of cancer recurrence.
- Possible side effects of radiation therapy: These can include skin changes, fatigue, and a slight risk of other cancers.
Mastectomy
A mastectomy is a surgical procedure that involves the removal of the entire breast tissue. It’s one of the primary treatments for breast cancer, especially in cases where the tumour is large, there are multiple tumours, or the patient has a high risk of recurrence.
Immediate reconstruction can be performed at the same time as mastectomy and in most cases, we are able to preserve the overlying skin of the breast and the nipple to achieve a good cosmetic outcome and not compromise on cancer treatment.
Benefits
- Reduces the risk of recurrent breast cancer: By removing all breast tissue, the risk of cancer returning is minimised.
- Typically eliminates the need for radiation therapy: Most mastectomy patients don’t require postoperative radiation.
Risks and considerations
- More invasive: A more extensive procedure than lumpectomy, leading to a longer recovery period.
- Possible longer hospital stay and recovery time if coupled with reconstruction: Patients often require several days in the hospital post-reconstructive surgery.
- Drains: Most patients will need to go home with a drainage bottle for a short period of time.
- Potential side effects: These can encompass pain, numbness, swelling, and limited arm mobility.
Comparing Lumpectomy (breast conserving therapy) & Mastectomy
Both breast conserving therapy (lumpectomy + radiotherapy) and mastectomy offer effective treatment for breast cancer. However, their impact on survival rates, recurrence, post-surgery quality of life, and cosmetic outcomes varies:
Survival Rates: Same
Lumpectomy: Studies have shown that for early-stage breast cancer, the long-term survival rate for patients undergoing lumpectomy followed by radiation therapy is comparable to that of mastectomy.
Mastectomy: Historically, mastectomy was considered the gold standard for treating breast cancer. However, advancements in detection and treatment have shown that for many early-stage breast cancers, survival rates are similar between mastectomy and lumpectomy with radiation.
Recurrence Rates: Same
Lumpectomy: Risk of cancer recurrence in the same breast after breast conserving therapy is the same when compared to mastectomy.
Mastectomy: The risk of local recurrence (cancer coming back in the same breast) is minimal since the entire breast tissue is removed. However, there’s still a small risk of chest wall recurrence or cancer in the opposite breast.
Post-surgery Quality of Life
Lumpectomy: Many patients report a better quality of life post-lumpectomy due to the preservation of the breast and shorter recovery time. The psychological impact of retaining one’s breast can also contribute to better overall well-being.
Mastectomy: The quality of life post-mastectomy can vary. Some patients feel a sense of security knowing the entire breast tissue is removed, while others may face challenges related to body image and self-esteem, especially if they opt out of reconstruction.
Cosmetic Outcomes
Lumpectomy: The goal is to remove the cancer while leaving the breast looking as close to its original state as possible. However, depending on the size and location of the tumour, there might be noticeable changes in the shape or size of the breast. Radiation therapy, often required post-lumpectomy, can also lead to changes in skin texture and breast appearance.
Mastectomy: A mastectomy results in the removal of the entire breast, leading to a more significant change in physical appearance. The cosmetic outcome can be improved with breast reconstruction, but the breast’s feel and appearance will be different from the original. Factors like scar placement and nipple reconstruction can also influence the cosmetic outcome.
Other Factors To Consider
Location and Stage of Cancer
- Tumour Size: Larger tumours, especially those that are disproportionate to the size of the breast, might require a mastectomy due to the extensive tissue removal required.
- Multiple Tumours: If there are multiple tumours in different areas of the breast (multicentric cancers), a mastectomy might be recommended.
- Stage of Cancer: Early-stage cancers that are confined to a small area are often suitable for lumpectomy, while more advanced cancers that have spread extensively within the breast might require mastectomy.
Size and Shape of the Breasts
- Breast Size: In smaller breasts, even a small tumour might require the removal of a significant portion of tissue, making mastectomy a more feasible option.
- Cosmetic Outcome: The expected cosmetic result post-surgery can influence the decision. For instance, removing a large tumour from a small breast via lumpectomy might result in a significant deformity.
Patient’s Age and Overall Health
- Age: Younger patients might lean towards lumpectomy to preserve the breast, especially if they’re concerned about body image. Conversely, older patients might opt for mastectomy to reduce the risk of recurrence and avoid radiation therapy.
- Health Status: Patients with other significant health issues might opt for the procedure with the least postoperative complications and quickest recovery.
Genetic Factors and Family History
- Genetic Mutations: Individuals with mutations in genes like BRCA1 or BRCA2 have a higher risk of developing breast cancer and might opt for prophylactic mastectomy to reduce this risk.
- Family History: A strong family history of breast cancer can influence the decision, with some individuals choosing mastectomy for peace of mind.
Previous Radiation Exposure
Patients who have previously undergone radiation therapy to the chest, especially at a young age (e.g., for Hodgkin’s lymphoma), might be advised to choose mastectomy due to the increased risk of secondary radiation-induced breast cancer.
Patient Preference
- Peace of Mind: Some patients feel more secure knowing the entire breast tissue is removed, reducing the risk of local recurrence.
- Body Image Concerns: The desire to maintain a natural breast appearance might lead some patients to choose a lumpectomy.
- Concerns about Radiation: Lumpectomy is often followed by radiation therapy. Patients concerned about the side effects or logistics of radiation might opt for mastectomy to avoid it.
Conclusion
The choice between lumpectomy and mastectomy is multifaceted, influenced by medical, genetic, and personal factors. Patients should engage in thorough discussions with their breast surgeon, weighing the benefits and risks of each procedure, to make an informed decision tailored to their unique circumstances.
