What are my surgical options?

You and your surgeon will decide upon a lumpectomy (also referred to as breast conservation) or a mastectomy, based upon many factors such as:

  • Type of breast cancer. For the two most prevalent types -- infiltrating ductal or infiltrating (or "invasive") lobular carcinoma -- a lumpectomy may suffice, since these types are usually contained within one portion of the breast in a clearly delineated tumor. However, if the cancer is spread throughout the breast tissue, a mastectomy may be necessary.
  • Absolute size of tumor. The larger the tumor, the more likely a mastectomy will be required and will likely offer a better cosmetic result.
  • Location of tumor(s). If the tumor is located in a place that would diminish a lumpectomy's cosmetic results (e.g., around or beneath the nipple), a mastectomy might be the preferred alternative.
  • Size of tumor relative to breast size. If you are small-breasted with a fairly large tumor, a mastectomy with reconstruction will likely provide the better cosmetic result. If you are large-breasted, removal of the tumor by lumpectomy might not even be noticeable.
  • Other health issues. Since a lumpectomy is almost always followed by radiation treatments, you may not be a candidate for lumpectomy if you are unable to have radiation for a variety of other, unrelated health reasons. For example, if you have certain collagen vascular diseases or skin disorders, you may or may not be a candidate for either radiation or reconstructive surgery, due to potential complications.

Taking into account all these factors, your surgeon will propose the best course of treatment for you. Sometimes he or she might offer you a choice, and sometimes the recommendation might be strongly directed to one or the other alternative. You must make the final decision yourself. Some women opt for a mastectomy even though their doctors say that lumpectomy will suffice, because it provides them with more emotional comfort.