Lumpectomy vs. Mastectomy: Making a Decision

June 20, 2018 | by Kevin Chesley

Amy Polverini CV Bio Photo Amy Polverini, M.D.
Many factors, including tumor size, influence the decision of whether to choose a lumpectomy or a mastectomy when a patient is facing breast cancer. Amy Polverini, M.D., an assistant clinical professor in the Division of Surgical Oncology in the Department of Surgery at City of Hope, sheds some light on all of the factors to be considered when making this important choice.

Conservation or Removal

“The two main treatment branches are breast-conserving therapy, which takes out the tumor but leaves the majority of breast tissue so the patient still has their own breast, or mastectomy, which removes the breast entirely,” Polverini explained.
Many women in the early stages of breast cancer are candidates for both. However, factors such as breast size and the extensiveness of the disease play a role as well.

The Lumpectomy Process 

Breast-conserving therapy — or lumpectomy — begins with localized pre-op. Polverini explains the process: “A radiologist places a wire into the cancer, and we dissect down to remove the tumor. We include a small margin of healthy tissue. This tends to be an outpatient surgery, and patients tend to recover really well — there is maybe some soreness.”

Kinds of Mastectomies

If removal of the entire breast is necessary, there are options involved with this procedure as well. “A simple, or total, mastectomy removes all the breast tissue, along with the nipple, skin and areola,” Polverini said. “This results in basically a flat incision on the chest wall. Skin-sparing and nipple-sparing mastectomies involve reconstruction with a plastic surgeon.” A skin-sparing mastectomy leaves the envelope of the breast intact. A plastic surgeon then places an implant beneath the chest muscles, matching the reconstructed breast to the other breast.
A nipple-sparing mastectomy uses a different method of entry. “We do a small incision under the nipple or at the base of the breast, then we remove the breast tissue, but patients keep all of their skin, the nipple, the areola — everything is in place,” Polverini said. “Most of the time we will do a reconstruction after the radiation is completed, because radiating a freshly reconstructed breast increases the risk for contraction and infection.”

Lymph Node Factors

Another type of mastectomy, the radical (or modified radical), involves the removal of multiple lymph nodes as well as the breast itself. This kind of surgery can bring with it a complication called lymphedema, in which fluid collects in the arm on the same side as the affected breast. “We take a very proactive approach” to avoid this, Polverini said. “Specialized surgeons do a microvascular surgery to help the lymphatic flow from the underarm.”
The decision process is different for every patient, Polverini said. “No two breast cancers are the same. I always encourage patients to listen with an open mind. I wipe the slate clean for all my patients and sit down and have a discussion regarding their specific cancer and what options for treatment are open to them.”
“The most common request I get is ‘What would you choose?’ and I always decline an answer. It’s a personal decision that involves the patient’s concerns,” Polverini said. However, she adds: “No matter what you choose, the survival is the same. They’re all excellent options.”
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If you are looking for a second opinion about your breast cancer diagnosis or consultation about your treatment, request an appointment online or contact us at 800-826-4673. Please visit Making Your First Appointment for more information.

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