Choosing Between Lumpectomy and Mastectomy for Breast Cancer

Some women have a choice between mastectomy and lumpectomy.  This video reviews the issues that commonly factor into that decision.

Read the full video transcript below:

Some women with breast cancer will have a choice between mastectomy and lumpectomy. In this video, we'll review some of the disease factors and some of the patient factors that can help you arrive at the right decision for you.

First, let's consider the patient factors. 

For some women, there are factors entirely separate from their cancer that make a mastectomy the better option. For instance, there are some genetic mutations which place them at very high risk for developing a second cancer down the road. That might make them more likely to choose a mastectomy than a lumpectomy.

For some women, they may simply have a preference to have a mastectomy. Perhaps, for instance, they're so sick of mammograms they don't want to have to deal with the follow-up after breast conservation. Finally, for some women, lumpectomy is prohibited. They can't have one because perhaps they've had radiation therapy in the past, or maybe they're early on in a pregnancy.

There are also patient factors that can favor lumpectomy over mastectomy. Again, patient preference may play a role if the patient simply does not want to lose the breast and wants to maintain their anatomy. Also, some patients, especially older patients, may have other medical issues which can make mastectomy surgery too risky, and a lumpectomy is safer.

Now let's look at disease factors. 

First, we'll look at the factors that favor mastectomy. One of the most common reasons for a mastectomy is a large tumor to breast ratio. That can be a confusing term, which basically just means that the size of the tumor is big compared to the size of the breast. Some women have very small breasts, and even a small or medium-sized tumor is too big to leave a reasonable cosmetic result after lumpectomy, so they have to have a mastectomy.

Another classic reason for mastectomy is a tumor that involves multiple quadrants of the breast, or also known as multicentric disease. Sometimes, a mammogram shows what's called diffuse calcifications or small bits of calcium that indicate a much wider spread of tumor throughout the entire breast. This is another reason to choose mastectomy over lumpectomy.

And finally, sometimes the tumor grows right up to the edge of what the surgeon removes. That's called a positive margin. Now, most of the time, a surgeon has room to go back a second or even a third time to get a negative margin. But if the tumor is always at the margin, eventually, a mastectomy is inevitable.

The disease factors that favor lumpectomy are the flip side of the coin: small tumor to breast ratio, single quadrant involved, limited calcifications, and negative surgical margins. 

This is not medical advice. Talk to your doctor before making any medical decisions.