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Lumpectomy or Mastectomy?

“Would you choose lumpectomy or mastectomy if you had to choose today?”

Most answer “mastectomy because I don’t want to worry about this again.” This answer is full of misconceptions – which is the reason why I ask it.

Most patients don’t realize that lumpectomy (removal of the tumor and surrounding tissue) combined with Radiation gives almost equivalent recurrence and survival results when compared with mastectomy. In other words, there may be very few if any benefits to one treatment choice over the other.

Still, lumpectomy is not for everyone and the final decision should be made after careful consideration of all issues. There are some early cancers that are not appropriate for lumpectomy. These include: patients who have had prior chest wall radiation, patients with genetic mutations (such as the BRCA 1 or 2 mutation), or those with multiple small tumors in the breast. Still over 80% of patients ARE candidates for breast conservation and should be given this option.

Several issues that all newly diagnosed breast cancer patients should discuss with their Breast Surgeon are:

• Will Breast MRI help me decide between lumpectomy and mastectomy (as this could pick up on previously undiscovered areas of cancer in both breasts);

• What are the cosmetic implications of the two procedures (and are any cosmetic procedures necessary on the opposite side); and

• How will my breasts be followed in the future to pick up on a recurrence or second cancer?

Remember, breast conservation is an equivalent option for most early breast cancers. Lumpectomy should be discussed and the pros and cons clearly demonstrated for the patient prior to choosing definitive surgery.


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