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Lumpectomy or mastectomy: How to decide?

When it comes to surgery, should you choose lumpectomy or mastectomy? Our article includes feedback from women on the choices they made, and why.

Roughly 55,000 new cases of breast cancer are identified in the UK each year, and many of the women diagnosed will ask themselves, ‘Lumpectomy or mastectomy, how to decide?’ Nearly all women will have surgery as part of their treatment, but early detection means most of those diagnosed will be likely candidates for breast-conserving surgery or lumpectomy, rather than a full mastectomy.

 

Until a quarter of a century ago, radical surgery was the only option, so nobody had to decide between lumpectomy or mastectomy. Mastectomies were first performed in the UK in the early 1900s. Up until the 1970s, most women underwent radical mastectomy – a dramatic procedure that removes the breast tissue, nipple and areola, as well as the underarm lymph nodes and chest wall muscles on the affected side.

 

The modified radical mastectomy, introduced in the 1960s, reduced the extent of the surgery to only the breast area and lymph nodes, with minimal impact on the chest muscles. This is the most common type of mastectomy performed today – particularly when a woman is unable to have breast-conserving surgery.

 

A lumpectomy procedure consists of removing only the lump and surrounding area, preserving the majority of the breast. The 1980s brought considerable advances in lumpectomies and other forms of breast-conserving surgery, and today just over half of all women in the UK who have breast cancer surgery opt for lumpectomy.

Lumpectomies typically require five to seven weeks of radiotherapy following surgery, in order to ensure that all cancerous cells are treated. Research has shown that the combination of lumpectomy plus radiotherapy has equal long-term survival rates to a mastectomy, which is reassuring.

 

Even with equal results, though, half of breast cancer patients who are eligible for a lumpectomy undergo a mastectomy instead. Why and how do they make that decision?

 

Studies over the past 20 years have shown several key factors influencing the use of mastectomy over lumpectomy/radiotherapy, including:

 

Yet despite some major influences in favour of mastectomy, breast-conserving surgery is increasingly the preferred option today. Women choose lumpectomy over mastectomy to preserve their natural breast, and their cleavage, for as long as they can and ultimately the decision on which type of surgery to have comes down to a woman’s personal choice. We talked to several women about the procedure they opted for, and why.

 

My body – my decision

 

“It was great to wake up with some of my breast left” – Kim’s story
Kim, 48, who is celebrating her tenth year of being cancer-free, is a third-generation survivor. Her grandmother had a radical mastectomy in 1958 and her mother underwent a modified radical mastectomy in 1978. Almost 20 years later, Kim opted for a lumpectomy. “Although I was OK with removing my breast if I had to, it was really cool waking up [after surgery] and having some of my breast left on my chest.”

 

“I needed a wider margin excised after my lumpectomy” – Libby’s story
Libby also chose a lumpectomy. “We were assured that since I had such early stage breast cancer a lumpectomy would be completely sufficient to get rid of all the cancer. Ironically, though, I had to go back three days after my original lumpectomy to have more tissue removed because my surgeon didn’t feel, based on the returned lab report, that she had got enough of a margin.

 

“I must say that was a bit traumatic for me and my husband, but we knew we were in good hands, so that made it a bit easier to handle. It was three years this past January since my diagnosis and treatment, and I’m fortunate enough to say I’ve had no further problems and remain cancer-free. And every day of my life now is the greatest gift.”

 

“I feel good about choosing lumpectomy” – Kathy’s story
Kathy still feels good about her lumpectomy decision. “After doing as much reading and research as I could, I moved on to talk with my GP, with friends—some of whom had lumpectomies and others who had complete mastectomies—and also my healthcare team. In everything I was able to discover about my kind of cancer and tumour, there was no research that indicated any significant benefit to having a mastectomy. I felt, and still do feel, very comfortable with my decision.”

 

“I chose mastectomy so I could have reconstruction with minimal scarring” – Lynn’s story
Lynn was diagnosed with DCIS – non-invasive cancer. “The lumpectomy would have removed 20-30% of the breast tissue because of the location near the middle and at the back near the breast plate. There was no guarantee that future lumpectomies would not be required in other areas, as the entire breast showed clusters of calcification.

 

“I decided on a mastectomy in order to have reconstruction with minimal scarring. A series of lumpectomies would have made a future reconstruction difficult in my case. This turned out to be the best decision for me, since DCIS was found in other areas and I would have lost this breast anyway.

 

“I have had excellent treatment and no problems with either surgery – mastectomy or reconstruction.”

 

If you’re thinking about lumpectomy or mastectomy and wondering how to decide, we hope this article will help you make up your mind.