Lumpectomy or mastectomy??? confused!!!

I am copying over a post put together by beesie, on of the resident experts on the boards. It gives a good, non-partial list of things to consider as your mom makes her decisions:

"Some time ago I put together a list of considerations for  someone who was making the surgical choice between a lumpectomy,  mastectomy and bilateral mastectomy.  I've posted this many times now  and have continued to refine it and add to it, thanks to great input  from many others.  Some women have gone through the list and decided to  have a lumpectomy, others have chosen a single mastectomy and others  have opted for a bilateral mastectomy. So the purpose is simply to help  women figure out what's right for them - both in the short term but more importantly, over the long term. 

Before getting to that list, here is some research that  compares long-term recurrence and survival results. I'm including this because sometimes women choose to have a MX because they believe that it's a more aggressive approach.  If that's a big part of someone's rationale for having an MX or BMX, it's important to look at the research to see if it's really true. What the research  has consistently shown is that long-term survival is the same regardless of the type of surgery one has. This is largely because it's not the  breast cancer in the breast that affects survival, but it's the breast  cancer that's left the breast that is the concern. The risk is that some BC might have moved beyond the breast prior to surgery. So the type of  surgery one has, whether it's a lumpectomy or a MX or a BMX, doesn't  affect survival rates.  Here are a few studies that compare the  different surgical approaches:

Lumpectomy May Have Better Survival Than Mastectomy

Twenty-Year Follow-up of a Randomized Trial Comparing Total Mastectomy, Lumpectomy, and Lumpectomy plus Irradiation for the Treatment of Invasive Breast  Cancer

Twenty-Year Follow-up of a Randomized Study Comparing Breast-Conserving Surgery with Radical Mastectomy for Early Breast Cancer

Now, on to my list of the considerations:

• Do you want to avoid radiation? If your  cancer isn't near the chest wall and if your nodes are clear, then it  may be possible to avoid radiation if you have a mastectomy. This is a  big selling point for many women who choose to have mastectomies. However you should be aware that there is no guarantee that radiation may not be necessary even if you have a mastectomy, if some cancer cells are found near the chest wall, or if the area of  invasive cancer is very large and/or if it turns out that you are node  positive (particularly several nodes).
• Do you want to avoid hormone therapy (Tamoxifen or an AI) or Herceptin or chemo? It is very important to understand that if it's believed necessary or  beneficial for you to have chemo or take hormone therapy, it won't make  any difference if you have a lumpectomy or a mastectomy or a bilateral  mastectomy.  (Note that the exception is women with DCIS or  possibly very early Stage I invasive cancer, who may be able to avoid  Tamoxifen by having a mastectomy or a BMX.)
• Does the length of the surgery and the length of the recovery period matter to you? For most women, a lumpectomy is a relatively easy surgery and recovery.  After a lumpectomy, radiation usually is given for 6 weeks. A mastectomy is a longer, more complex surgery and the recovery period is longer.
• How will you deal with the side effects from Rads? For most patients the side effects of rads are not as difficult as they expected, but most women do experience some side effects. You should be prepared for some temporary discomfort, fatigue and skin irritation,  particularly towards the end of your rads cycle. Most side effects go  away a few weeks after treatment ends but if you have other health  problems, particularly heart or lung problems, you may be at risk for  more serious side effects. This can be an important consideration and  should be discussed with your doctor.
• Do you plan to have reconstruction if you have a MX or BMX? If so, be aware that reconstruction, even "immediate" reconstruction, is  usually a long process - many months - and most often requires more than one surgery. Some women have little discomfort during the  reconstruction process but other women find the process to be very  difficult - there is no way to know until you are going through it.
• If you have a MX or BMX, how will you deal with possible complications with reconstruction? Some lucky women breeze through reconstruction but unfortunately, many have  complications. These may be short-term and/or fixable or they may be  long-term and difficult to fix. Common problems include ripples and  indentations and unevenness. You may have lingering side effects (muscle pain, spasms, itching, etc.) on one side or both (if you have a BMX).  If you don't end up with symmetry (symmetry is not a sure thing by any means, even if you have a bilateral mastectomy with reconstruction done on both sides at the same time), will you regret  the decision to remove your breasts or your healthy breast? Are you  prepared for the possibility of revision surgery?
• How you do feel about your body image and how will this be affected by a mastectomy or BMX? A reconstructed breast is not the same as a real breast. Some women love  their reconstructed breasts while some women hate them.  Most probably  fall in-between. Reconstructed breasts usually looks fine in clothing  but may not appear natural when naked. They may not feel natural or move naturally, particularly if you have implant reconstruction.  If you do  choose to have a MX or BMX, one option that will help you get a more  natural appearance is a nipple sparing mastectomy (NSM). Not all breast  surgeons are trained to do NSMs so your surgeon might not present this  option to you. Ask your surgeon about it if you are interested and if  he/she doesn't do nipple sparing mastectomies, it may be worth the  effort to find a surgeon who does do NSMs in order to see if this option is available for you (your area of cancer can't be right up near the  nipple).
• If you have a MX or BMX, how do you feel about losing the natural feeling in your breast(s) and your nipple(s)? Are your nipples important to you sexually? A MX or BMX will change your  body for the rest of your life and you have to be prepared for that.  Keep in mind as well that even if you have a nipple sparing mastectomy,  except in rare cases (and except with a new untested reconstruction  procedure) the most feeling that can be retained in your nipples is  about 20% - the nerves that affect 80% of nipple sensation are by  necessity cut during the surgery and cannot be reconnected. Any  breast/nipple feeling you regain will be surface feeling only (or  phantom sensations, which are actually quite common and feel very real); there will be no feeling inside your breast, instead your breast will  feel numb. For some, loss of breast/nipple sensation is a small price to pay; for others, it has a huge impact on their lives.
• If you have a MX or BMX, how will you deal emotionally with the loss of your breast(s)? Some women are glad that their breast(s) is gone because it was the source  of the cancer, but others become angry that cancer forced them to lose  their breast(s). How do you think you will feel? Don't just consider how you feel now, as you are facing the breast cancer diagnosis, but try to think about how you will feel in a year and in a few years, once this  diagnosis, and the fear, is well behind you.
• If you have a lumpectomy, how will you deal emotionally with your 6 month or annual mammos and/or MRIs? For the first year or two after diagnosis, most women get very stressed  when they have to go for their screenings. The good news is that usually this fear fades over time. However some women choose to have a BMX in  order to avoid the anxiety of these checks. 
• Will removal of your breast(s) help you move on from having had cancer or will it hamper your ability to move on? Will you feel that the cancer is gone because your breast(s) is gone? Or  will the loss of your breast(s) be a constant reminder that you had  breast cancer?
• Appearance issues aside, before making this decision you should find out what your doctors estimate your recurrence risk will be if you have a lumpectomy and radiation. Is this risk  level one that you can live with or one that scares you? Will you live  in constant fear or will you be comfortable that you've reduced your  risk sufficiently and not worry except when you have your 6 month or  annual screenings? If you'll always worry, then having a mastectomy  might be a better option; many women get peace of mind by having a  mastectomy.  But keep in mind that over time the fear will fade, and  that a MX or BMX does not mean that you no longer need checks - although the risk is low, you can still be diagnosed with BC or a recurrence  even after a MX or BMX. Be aware too that while a mastectomy may  significantly reduce your local (in the breast area) recurrence risk, it has no impact whatsoever on your risk of distant recurrence (i.e.  mets).
• Do you know your risk to get BC in your other (the non-cancer) breast? Is this a risk level that scares you? Or is this a risk level that you can live with? Keep in mind that breast cancer very rarely recurs in the  contralateral breast so your current diagnosis doesn't impact your other breast. However, anyone who's been diagnosed with BC one time is at higher risk to be diagnosed again with a new primary breast cancer  (i.e. a cancer unrelated to the original diagnosis) and this may be compounded if you have other risk factors. Find out your risk level  from your oncologist. When you talk to your oncologist, determine if  BRCA genetic testing might be appropriate for you based on your family  history of cancer and/or your age and/or your ethnicity (those of  Ashkenazi Jewish descent are at higher risk). Those who are BRCA  positive are very high risk to get BC and for many women, a positive  BRCA test result is a compelling reason to have a bilateral mastectomy.  On the other hand, for many women a negative BRCA test result helps with the decision to have a lumpectomy or single mastectomy rather than a  bilateral. Talk to your oncologist. Don't assume that you know what your risk is; you may be surprised to find that it's much higher than you  think, or much lower than you think (my risk was much less than I would  ever have thought).
• How will you feel if you have a lumpectomy or UMX and at some point in the future (maybe in 2 years or maybe in 30 years) you  get BC again, either a recurrence in the same breast or a new BC in  either breast? Will you regret your decision and wish that you'd had a bilateral mastectomy? Or will you be grateful for the extra time that you had with your breasts, knowing that you made the best  decision at the time with the information that you had?
• How will you feel if you have a bilateral mastectomy and no cancer or high risk conditions are found in the other breast? Will you question (either immediately or years in the future) why you made  the decision to have the bilateral? Or will you be satisfied that you  made the best decision with the information you had?

.I hope that this helps. And remember.... this is your decision. How  someone else feels about it and the experience that someone else had  might be very different than how you will feel about it and the  experience that you will have.  So try to figure out what's best for  you, or at least, the option that you think you can live with most  easily, given all the risks associated with all of the options.  Good  luck with your decision!"

I am going to copy some things over from BCO main page for you:

Radiation therapy — also called radiotherapy — is a highly targeted and highly effective way to destroy cancer cells in the breast that may stick around after surgery. Radiation can reduce the risk of breast cancer recurrence by about 70%. Despite what many people fear, radiation therapy is relatively easy to tolerate and its side effects are limited to the treated area.

External radiation, sometimes called external beam radiation, is the most common type of radiation. In this technique, a large machine called a linear accelerator aims a beam of high-energy radiation at the area affected by the cancer. This form of radiation is given on an outpatient basis 5 days a week, over 5 to 7 weeks, depending on the particular situation.

Researchers are studying internal radiation, sometimes called partial-breast radiation or brachytherapy, for use after lumpectomy to see how the benefits compare to the current standard of external radiation to the whole breast. Internal radiation methods typically use small pieces of radioactive material, called seeds, which are placed in the area around where the cancer was. The seeds emit radiation into the surrounding tissue. The area that's very close to the site of the original cancer is the area that is at highest risk of recurrence.

Internal radiation is most commonly delivered using multiple small tubes or catheters, or using a balloon-catheter device called MammoSite.

• In multi-catheter internal radiation, tiny tubes (catheters) are sewn under the skin in the area where the cancer was. The ends of the tubes stick out through little holes in the skin. Tiny stitches hold the tubes in place.
  
  The doctor or a machine places radioactive seeds into the tubes just long enough to deliver the prescribed dose. If low-dose radiation seeds are used, the treatment can take a few days. During treatment, you stay in the hospital because there is radioactivity inside you. Special precautions are taken to keep you and those around you safe from the radiation. Once the treatment is done, the radioactive seeds, stitches, and tubes are removed. Then you can go home.
  
  If high-dose radioactive seeds are used, each seed might be left in for up to 10 minutes. The seeds are then removed and you are free to leave the treatment center. You do not remain radioactive after the seeds are removed. Once the course of treatment is done, the tubes are removed. The course of internal radiation treatment is usually 1 week (5 days), with 2 treatments each day.
• In balloon-catheter internal radiation (the MammoSite system), a special tube with a balloon on the end is used. With careful planning, the balloon is placed into the area where the cancer was. The tube comes out through a little hole in the skin. The balloon is filled with fluid to hold the balloon and tube snugly in place. The MammoSite can be inserted in an operating room or in a surgeon's office and stays in place about a week and a half.
  
  During each treatment, a machine places a radioactive seed into center of the balloon for about 5 to 10 minutes — just long enough to deliver the prescribed dose of radiation. A total of 10 treatments are usually given over 5 days. That means 2 treatments per day, about 6 hours apart. When the final treatment is done, the balloon is removed through the small hole in the skin.

Benefits and drawbacks of internal radiation

Internal radiation was developed to reduce risk of recurrence while shortening the amount of time it takes to get radiation treatment. Internal radiation also limits the dose of radiation (and associated side effects) to surrounding normal tissue. Internal radiation also MAY be able to be given again — but only to another part of the breast — if a new breast cancer is diagnosed in the future. External, whole-breast radiation usually can't be given again to the same breast.

Compared to external radiation, internal radiation has several benefits:

• The treatment time is shorter — 1 week versus up to 7 with external radiation. Intraoperative internal radiation has an even shorter treatment time because it's done during surgery.
• Radiation is given only to the area where the cancer is most likely to come back. Less of your body receives radiation, so there may be fewer side effects.
• The preliminary results from the small number of studies done so far show a very low risk of recurrence after internal radiation.

But there are some unknowns involved with internal radiation that should be discussed with your doctor as you make your treatment decisions:

• Internal radiation has no long-term track record. This means that the benefits and side effects of internal radiation aren't completely understood. The benefits and side effects of external, whole-breast radiation have been studied for more than 30 years in thousands of people. Talk to your doctor about how to make a decision between a new approach and an established approach.
• Most internal radiation techniques require extra training and experience. Doctors have to know how to select appropriate people for the treatment and how to properly deliver the radiation.

Radiation can be given during lumpectomy surgery, after the cancer has been removed. This is called intraoperative radiation therapy (sometimes abbreviated as IORT). While the underlying breast tissue is still exposed, a single, high dose of radiation is given directly to the area where the cancer was.

One method of intraoperative radiation uses the linear accelerator (used in external radiation) to deliver an electron beam to the area where the cancer was. Radiation with electrons only goes a short distance and can be concentrated on the area at risk. Special techniques are used to protect the underlying tissue. The procedure takes about 2 minutes and then the surgery is completed as usual.

Another technique is known as high-dose-rate remote afterloading intraoperative radiation. This procedure uses a small tube, which is placed in the area where the cancer was. The tube is connected to a computerized radiation machine, which delivers a high dose of radiation through the tube. The procedure takes about 5 to 10 minutes.

Doctors don’t agree on whether intraoperative radiation therapy is a good alternative to whole-breast radiation after lumpectomy, which is the standard of care. More research is being done to help figure out which women may be good candidates for intraoperative radiation therapy during lumpectomy instead of whole-breast radiation after lumpectomy.

Intraoperative radiation therapy is available only at certain treatment centers. This is because using IORT to treat breast cancer is relatively new and the equipment can be expensive. If you’re scheduled to have lumpectomy and are interested in intraoperative radiation therapy, talk to your doctor. Together you can decide if IORT is a good choice for you as well as whether there is a treatment center in your areas that offers IORT.

A couple more things I found:

Ten Key Points About Radiation Therapy  

• Radiation is a local, targeted therapy designed to kill cancer cells that may still exist after surgery. Radiation is given to the area where the cancer started or to another part of the body to which the cancer spread.
• The actual delivery of radiation treatment is painless. But the radiation itself may cause some discomfort over time. 
• External radiation treatment, the most common kind of radiation therapy, does not make you radioactive.
• Treatment is usually given 5 days a week for up to 7 weeks. Sometimes radiation may be given twice a day for 1 week.
• Since the daily appointments usually take about 30 minutes, you'll most likely be able to follow most of your normal routine during treatment.
• Radiation will not make you lose your hair, unless radiation is given to your head.
• In the area where you are receiving radiation, your skin can turn pink, red, or tan, and may be sensitive and irritated. Creams and other medicines can soothe these symptoms.
• During your treatment course, you may feel tired. This feeling can last for a few weeks -- even months -- after treatment ends.
• Most radiation side effects are temporary.
• Radiation therapy can significantly decrease the risk of cancer returning after surgery.

and.....

Myths About Radiation Therapy  

It is natural for anyone beginning a new medical treatment to be a little fearful. For people beginning radiation therapy, this fear seems to be heightened by some common misunderstandings about the treatment.

• Radiation therapy is painful.
  Not really. Most patients have no sensation of radiation when the machine is delivering the daily treatment. A few patients report a slight warming or tingling sensation in the area while the radiation machine is on. Over time, the skin in the area being treated will gradually become dry, sore, itchy, or burning. These feelings can be uncomfortable, but usually not enough for a person to stop or interrupt her treatment.
• Radiation therapy will cause me to be radioactive.
  Only in certain cases. If you are treated with external radiation, you will not be radioactive at any time. The radiation you receive delivers its dose to your tissues within an instant — there is no lingering radiation once the treatment machine is turned off. As you try to keep to the normal rhythms of your life, it is important to remind friends, family, and co-workers that you will not expose them to radiation. If you receive internal radiation as a "boost" at the end of treatment, you will be radioactive while the radioactive material is in you. While you receive this internal treatment, you will be secluded in the hospital in a private room.
• Radiation therapy will cause me to lose my hair.
  No. Not on your head, anyway. If you are undergoing just radiation treatment, you won't lose the hair on your head (the hair on your nipple or in your lower armpit next to the breast might come out during radiation, but will grow back). The misperception that radiation makes you lose your hair comes from the confusion of radiation and chemotherapy. Since many patients begin radiation treatment right after their chemotherapy, it's understandable that the side effects of the two therapies are confused. Because chemotherapy is a "systemic" treatment, meaning it affects the whole body, you will likely lose your hair during this treatment. Radiation therapy is a "local" treatment, which means it is directly focused on the tissue of the breast area, and possibly nearby lymph nodes. Unless radiation is targeted at your head, you will not lose your hair from radiation.
• Radiation therapy will cause nausea and vomiting.
  Not usually. Radiation treatment to the breast area and lymph nodes for early-stage breast cancer usually doesn't cause nausea or vomiting.
• Radiation therapy will increase my chance of getting more breast cancer.
  No. The purpose of having breast radiation therapy is to reduce the risk of recurrence in that breast. Radiation to one breast does not increase your chance of getting cancer in the other breast. It's true that there is a relationship between radiation and cancer: Adolescent girls receiving chest radiation for Hodgkin's disease have a higher risk of getting breast cancer because the newly developing breast is especially vulnerable to radiation damage. And a small percentage of women who were exposed to the atomic bomb blast at Hiroshima during World War II suffered from higher levels of breast cancer later in life. We now understand that this occurred because women were exposed to low levels of radiation over their entire body. The therapeutic radiation you will receive, however, is targeted precisely to the breast area, with almost no "scatter" to other areas of your body.

I have had both-had a masectomy on one side and lumpectomy on the other.  Getting a masectomy does not automatically clear you of radiation.  I still had to have radiation on masectomy side.  I have been through it all-chemo, rads, 6 surgeries in 16 months-wearing tissue expanders, reconstruction, lat flap.  If I could have-I would have done lumpectomy on both sides any day of the week.  The worst part of this whole process to me has been losing my breast and going through all the reconstruction.  I hate my masectomy breast.  My breast surgeon says there is nothing that states getting a masectomy is better for you statistically than a lumpectomy.  This is a very personal decision for each of us.  But-lumpectomy is way easier-mentally and physically than a masectomy-if you have a choice.  This is just MY opinion-but coming from someone who has had both so knows. 

My surgeon recommended lumpectomy when I questioned which to do. He said the recovery time would be so much quicker and the odds weren't any worse. In my case, I had to have a second surgery a 10 days later. I ended up with a lot of problems (that don't usually happen). The second surgery caused my breast to look much different, because of all the extra breast tissue taken out. So, if I had to go back and change my decision, in all honesty, I am not sure which I'd choose. I can only advise to choose carefully and ask a lot of questions. I also wish I had gotten a second opinion at another facility.

I had a lumpectomy first and had close margins so I was going to need another lumpectomy with rads following chemo. This happens occassionally. During my chemo time I did change my mind and had bmx instead. I did chose immediate DIEP recon, so I can't comment on what flat would be like, but I am happy I did both for the symmetry aspect. I did not need rads with the bmx.

The most important part of this decision is your mom's perspective. Some women feel really sad about losing a breast, like they were mutilated. Lumpectomy is best for them. Other women feel they can never trust a breast that was once diseased and need it removed. MX Is best for them.