Women who need surgery may be a candidate for either a lumpectomy (removal of the tumor and surrounding tissue) or a mastectomy (total removal of one or both breasts). Women may also choose to have reconstructive surgery after lumpectomy or mastectomy.
A lumpectomy (also called a partial mastectomy) is considered “breast-conserving” surgery because only the tumor and a surrounding area of normal breast tissue (called the margin) is removed. Lumpectomy is usually followed by a course of radiation therapy to make sure that any remaining cancer cells in the breast have been killed.
Your best surgical treatment comes about after a lengthy and detailed discussion with your doctor. Your lifestyle, preferences and psychological outlook should all be taken into consideration.
For lumpectomy, an estimated 50 percent of women with breast cancer are good candidates. Lumpectomy is an attractive surgical option because it is both extremely effective and also allows a woman to keep her breast. Studies show that women have an equal chance of surviving breast cancer whether they have a lumpectomy followed by radiation therapy or they have a mastectomy. With a lumpectomy, however, there is a slightly higher chance that the cancer can come back within the breast. This is called a local recurrence.
The location, size and type of tumor as well as the size of the patient’s breast are all important considerations when choosing a surgical option. Lumpectomy (breast-conserving surgery) may not be the best choice when:
- The tumor is too large
- The tumor is located in an area where it is difficult to remove with good cosmetic results
- Two or more areas of cancer are found in one breast. This is called multifocal or multicentric disease. The tumor cannot be removed as a single lump so a mastectomy is required.
A single large or hard-to-access tumor may be treatable with chemotherapy or endocrine therapy prior to surgery in an attempt to decrease its size. This allows the surgeon to remove a much smaller amount of tissue during the lumpectomy.
Since radiation therapy is an important part of breast conservation, women who are not good candidates for post-operative radiation typically cannot undergo a lumpectomy. Women with the following conditions are generally advised not to consider lumpectomy:
- Women with prior radiation treatment to breast or chest area
- Women with connective tissue diseases such as scleroderma
- Women who are pregnant at the time of radiation therapy
The outer edges of the removed breast tissue are tested. If they contain cancer cells (called a positive margin), additional surgery (re-excision) is usually recommended to remove the remaining cancer. If it is not possible to clear the margins with re-excision(s), a mastectomy is usually necessary for successful treatment.