Advanced Breast Cancer: Managing Your Medical Care: Diagnosis To Treatment Decision

Surgery for breast cancer is either a Lumpectomy, a Partial Mastectomy or a Mastectomy.

Lumpectomy And Partial Mastectomy

During a lumpectomy, a surgeon preserves the breast while removing the tumor. In a typical situation,  the surgeon makes an incision, removes the cancerous tissue and then closes the opening. 

A larger tumor may require removal of a larger portion of the breast. This is known as a partial mastectomy.

A lumpectomy may result in a disfiguring dent A partial mastectomy may result in a larger dent. If a lumpectomy or partial mastectomy is coupled with plastic surgery (oncoplastic surgery), a wedge is removed and tissue under the skin is then pulled together to close the defect. That can leave the breast looking smaller, but otherwise normal. The same surgery can reduce the size of the other breast for a more normal appearance.

A lumpectomy or a partial mastectomy is generally followed by radiation therapy and sometimes by hormone therapy or chemotherapy. (Hormone and chemotherapy are known as Systemic Treatments because drugs travel through the bloodstream, thus circulating throughout the body).

If you are going to have a large lumpectomy or partial mastectomy followed by radiation and want a plastic surgeon to enhance the appearance of your breast, talk to the surgical oncologist and plastic surgeon who will do the work about the timing of the operation before the lumpectomy or partial mastectomy is scheduled. The operation generally needs to be done before radiation creates further changes in the breast.

Mastectomy

During a mastectomy, the surgeon removes the entire breast. As a general matter, mastectomies today are much less disfiguring than they used to be.

Mastectomies can be followed by a breast reconstruction.

If a mastectomy is recommended, see the Next Section.

Lumpectomy or Partial Mastectomy vs. Mastectomy

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

• 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 is usually done on an outpatient basis so you go home the same day. A mastectomy usually requires hospitalization. (Typically, patients leave the day after surgery). 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.

The Surgeon

Choose the surgeon (a surgical oncologist) with care. In addition to expertise and recent experience with your particular procedure, look for a doctor you are comfortable with. He or she will likely be taking care of you for a long time.

If you have selected a surgeon and then are told he cannot operate for a week or two, that is probably fine. Excellent surgeons are bound to be busy. In fact, there is a tricky point to consider: If a breast specialist can take you right away, it is legitimate to wonder whether he or she is busy enough to be the right person for you.

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