After a breast surgeon has evaluated you for breast cancer, you may be a offered the choice between lumpectomy+ radiation and a mastectomy.The choice is only offered if cancer lends itself safely to be treated by either option. This means that you will not be offered a lumpectomy if a tumour were not suitable for that treatment eg. if a tumour involved multiple areas of the breast. However, when the choice is offered to you, your survival will not be affected by the surgical treatment you choose, as long as you complete all treatments advised. When making the decision between lumpectomy and mastectomy discuss the following with your breast surgeon.
1) Need for radiation: Radiation is almost always given after a lumpectomy, whereas it can be avoided in certain cases after a mastectomy.
2) Options for reconstruction after mastectomy: A mastectomy may not be a mutilating surgery, often the skin and nipple areolar complex can be preserved at the time of surgery and the breast is removed and replaced with an implant or a flap.
3) Plan for surveillance/follow-up after surgery: Routine mammography for the treated side is necessary after a lumpectomy. If you undergo a mastectomy, mammography is needed for the opposite side. The side of the cancer is followed by clinical exam alone
4) The possibility of genetic/ hereditary breast cancer: In cases of known BRCA mutations, a bilateral mastectomy may be offered over the choice of lumpectomy and radiation. If you opt for a lumpectomy in this situation, annual MRI is also advised for surveillance given the higher risk of recurrence.
5) Expected cosmetic outcomes of either approach: Aesthetic outcomes of both approaches may be satisfactory. Sometimes patients opt for a bilateral mastectomy with reconstruction for symmetry. In cases of a lumpectomy, a symmetrization procedure may be offered for the opposite side. Radiation also affects the long-term appearance of the breast.It is important to be comfortable with the decision you make.
If one chooses a certain surgical approach and goes on to develop a recurrence, it doesn't always imply that the approach selected was wrong. It is also important for family members to help the patient make her own decision and not judge them for the choices they make. Regardless of which option is chosen, lifelong followup with your breast surgeon or oncologist is advised.