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Breast Cancer In Situ: Managing Your Medical Care: Diagnosis To Treatment Decision

Choosing Between Lumpectomy or Partial Mastectomy and a Mastectomy

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If there is a choice between a lumpectomy or partial mastectomy and a mastectomy, there are many factors to consider when deciding. For instance:

  • You may have an initial gut preference for mastectomy as a way to "take it all out as quickly as possible." However, in most cases, mastectomy does not provide any better chance of long-term survival or a better outcome from treatment. Studies following thousands of women for more than 20 years show that when a lumpectomy can be done, doing mastectomy instead does not provide any better chance of survival. 
  • Future testing for the possible return of breast cancer will not be affected whether a lumpectomy, partial mastectomy, or mastectomy is performed.
  • There is no difference in the rate at which breast cancer returns (a "recurrence").
  • A lumpectomy or partial mastectomy preserves the breast. A mastectomy doesn't. However, the breast can be reconstructed (if health insurance pays for the surgery, it has to also pay for the reconstruction.)
  • A lumpectomy is usually done on an outpatient basis. A mastectomy usually requires hospitalization. A mastectomy with reconstruction generally requires a longer hospital stay.
  • Age does not generally matter.
  • Cosmetics should not be the deciding factor. Reconstruction is now so refined that women who have reconstructions also feel good about their appearance. If it is done at same time as the surgery, you don't even have to wake up and see one side of your body totally different from the other.
  • If you have a mastectomy and prefer not to have reconstruction, you can choose to wear a breast pad prostheses.

If you have one of the genes that increase the risk of developing breast cancer, both breasts are at risk for the future development of cancer. You also have an increased risk for ovarian cancer. A mastectomy or even bilateral mastectomy may be more advisable because of a greater risk that a new tumor will develop in either breast. However, mastectomy is not mandatory in this setting if you are willing to accept future close monitoring of the breast and ovaries by imaging techniques such as mammography and MRI. Be sure to discuss this with your doctors.


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