Mastectomies aren't your only option

Finding out you have breast cancer is scary. Trying to figure out all of your options can be confusing and overwhelming. When all of those facts and emotions are combined, you may naturally want to be as aggressive as possible by choosing a mastectomy – or even a double mastectomy; but there’s value in taking the time to weigh all of your treatment options.

“Women may opt for a mastectomy with the mindset that they want all of the cancer out and don’t want to worry about it coming back,” said Rosemary Leeming, M.D., director of Geisinger’s Comprehensive Breast Program. “But more surgery doesn’t guarantee that the cancer won’t return.”

Many women with breast cancer also have the option of breast-conserving surgery with the same chance of overall cure.  Breast surgery, whether it’s a complete mastectomy or a lumpectomy, only treats the breast and surrounding tissue.  Treatment directed at cells outside the breast is called “systemic” therapy since it gets into someone’s whole system and can include anti-estrogen medications or chemotherapy.  “Breast cancer treatment usually involves a combination of surgery and systemic treatment and doing more surgery doesn’t change the need for additional “systemic” treatment, if it’s indicated,” said Dr. Leeming.

With a mastectomy, the entire breast and sometimes lymph nodes are removed. This is much more invasive surgery than a lumpectomy, usually requiring recovery time in the hospital.

“Breast-conserving surgery (a lumpectomy or partial mastectomy) removes the cancer with a rim of surrounding tissue, leaving the breast looking as normal as possible.” Dr. Leeming said. “The location and size of each person’s tumor is different, which means the amount of tissue removed during surgery varies from person to person.” 

Most women who opt for breast-conserving surgery also have radiation therapy, which treats the remaining breast tissue after the cancer has been removed.  Often, the entire breast is treated although newer techniques treat only the area where the cancer was. These “partial breast” radiation techniques can often be accelerated, to allow treatment over a week or less, compared to “whole breast radiation” which often takes three to six weeks.

There are risks and benefits to consider when weighing your option of a mastectomy or a lumpectomy with radiation therapy.

“The biggest benefit of lumpectomy combined with radiation is that overall survival is the same as with a mastectomy while the breast is preserved,” Dr. Leeming said. “Having a mastectomy usually means you won’t need radiation therapy, although some women still need it if the cancer is large or the lymph nodes are involved.” Dr. Leeming said. “The downside of a mastectomy is that it’s a bigger and longer operation with no improvement in survival for most women with early stage breast cancer.”

Some women find it hard to cope with the idea of losing their breasts, associating them with a part of their feminine identity, driving them to choose breast-conserving surgery.   Understanding that you can preserve the breast and have the same long-term outcome allows women to feel comfortable choosing this option.  Women who don’t have the choice of a lumpectomy or simply prefer a mastectomy, can consider immediate reconstruction in many cases, which can help reduce the sense of loss associated with breast removal.

“If you’re having a difficult time figuring out which option is best for you, speak with your doctor. He or she will be able to help you weigh the risks and benefits, with the ultimate goal of curing your cancer,” Dr. Leeming said.  “At Geisinger, we have a Multidisciplinary Breast Cancer Clinic staffed by all of the members of our breast team.  Women have options when it comes to breast cancer treatment.  We meet weekly with patients who have been recently diagnosed, to review their situation and help them make informed choices that are right for them.”