Surgery decision--lumpectomy vs mastectomy

Hi rokaw, and welcome to Breastcancer.org!

We know this is a very tough decision, but as keepthefaith pointed out, it's only one you can make with the help of your doctors. However, as you can already see, our amazing Community here is full of very helpful members who can help you talk through the decision process, and share their experiences. We know others will be by shortly to weigh in.

We look forward to hearing more from you soon, and wish you well, whatever surgery you decide!

--The Mods

This may help you make up your mind

http://www.vinniemyersteam.com/vinnie-portfolio-ga...

I have been there so I understand.. Why the need to make a decision ASAP? Unless you have a super fast growing cancer there is most def time to make informed choices. Remember medicine is a business and surgery pays well. I'm 43 now and I so wish I had options between lumpectomy and mastectomy I def would have chosen lumpectomy. My DR did an amazing job however these new foobs are not warm to the touch, have zero feeling and always feel like I'm wearing a bra 3 sizes to small due to scarring.. I know there are ladies from the other side who are so happy they chose mastectomy and that's awesome. I have implants but lots of women have diep flap surgery which is not implants so they would be completely different from what I have. You will live with this the rest of your life seeing the choice that you make. Not every woman who gets BC has a recurrence. In my opinion it's a huge price to pay for a what if scenario. Also make sure you see an oncologist before you decide on a surgery path. They may very well have options that you are unaware of. You are not a baby this is scary serious stuff here. Do the research so you can see what possible outcomes you may have. Pick an experienced well recommended plastic surgeon. There are surgeons who specialize in different types of surgery's.

Best Wishes

Welcome, rokaw2000 and anjil029. I am so sorry for the difficulties you are going through.

Many mastectomees do not have breast reconstruction. Some of us are "flat" by choice, some by medical necessity, and some are waiting for reconstruction procedures.

The choice of surgery type is so personal that nobody else can tell you which surgery would be best for you. You have to figure out what would get you to the "new normal" most satisfactory to you. We will support you in whatever you decide.

That's how I chose lumpectomy, the path of least resistance. I figured I could always get a mastectomy later, but once gone they were gone. I do worry when it comes time for imaging, but my understanding is that the risk of jumping to stage 4 is higher than local recurrence, and mastectomy won't necessarily prevent that.

It's a hard decision. I had great angst at the time and was frustrated by even being given the choice. I wanted someone to tell me what to do.

I was a lot like you - paralyzed with indecision. And, like a poster above, I wished someone would just tell me what to do. I hated having to make the decision.

But you know what? When the BS tried to convince me to do a lumpectomy after chemo and acted like I was crazy for considering MX ... that didn't sit well, either.

I had a BMX. It was a four hour surgery and implants were placed at the same time. I spent one night in the hospital. I have not had any further surgery. I did have an infection at five weeks post op that required IV antibiotics for three days.

Having a BMX allowed me to avoid rads (not always the case). I also do not have to have routine imaging or watch the concerning area on the non-cancer breast. I have eliminated as much breast tissue as possible. My reconstruction looks pretty good and fairly natural even without clothes with a scar line underneath.

However - it is a pretty big surgery. I had help for two weeks and didn't start to feel a lot better (normal) until probably six weeks. I'm still aware of the surgery -minimal skin sensation, unusual pulling or soreness at times. But I remind myself of why I chose this.

It's a hard spot to be in - making this decision. Don't rush into anything. And do consult a MO as well as getting at least two opinions. And in the end - remember that you did the best you could with the information you had!

I could not decide either.  Went over and over lumpectomy/mastectomy/double mastectomy, with DIEP.  Eventually chose lumpectomy, with the knowledge that insurance would have to pay if I subsequently decided to go the mastectomy/mastectomies route.  Insurance would have had to pay for the second surgery.  I had gone into the decision considering my breasts pretty much disposable.  Meanwhile I continued reading all the surgical threads on this site, and began to understood more clearly the reality of some of the risks of the larger surgery and reconstruction.  It was not long after surgery that I decided the lumpectomy had been enough.  I was truly surprised at how happy I was to still have my breast/s.  I was terrified of radiation, but managed with some grace, and, five years later, I know I made the right decision.  Although a pretty large chunk of my smallish breasts was removed, I look just fine, both clothed and unclothed.   

When I was diagnosed in 2015 initial reaction was to get rid of them both ! I guess I felt kind of betrayed by my boobs!

However my BS convinced me that a lumpectomy would be the better choice... I was still very shocked and freaked out and just wanted this invader that was trying to kill me out of my body !! So I did very little research about the process! When you are first diagnosed you are just worried about living !!! You don’t think about quality of life afterwards!

Anyway I had a lumpectomy chemo followed by radiation therapy. I have large breast so you could not even tell the difference in my breast at ... at first! About the time of my first post opt mamaogram my breast started to become so tender. I was in tears while the the tech preformed the test that i would need to have done every 6 months for an indefinite time! Also my breast has began to shrink, the tissue is very hard and I have some numbness!

SO as I type this I am sitting in a plastic surgeon office getting ready to discuss my options! Wishing that I had taken my time to research radiation side effects.. but that just seemed so far away in my treatment plan that I just didn’t know to ask ! I am going to haven a mastectomy sometime over the summer. I hope that the radiated breast able to have reconstruction!

So my advice is if you can try to take your time! I know it is hard! Because you are in damage control mode !! We have all been there! Sending you good vibes and best wishes that you will come to a decision that is right for you !

PS: no one can tell you about recurrence; for me, it was a way for me to say I'd done everything to protect myself. I do feel I have better protected myself against recurrence. I don't know where your doc got his stats about survival being longer with lumpectomy and rads. I had it all, plus a BMX, so I guess my odds are really good~!

I, too, am going through the struggle of determining the surgery path to take. I've pretty much decided on lumpectomy with immediate reconstruction aka Oncoplasty.

My MRI with contrast is tomorrow and if the left breast shows issues then this whole surgery thing will need to be revised. The waiting is the hardest part.....

I had a lumpectomy and am very happy that I had that choice. Radiation was annoying but I had no negative side effects, then or later.

Here's an impartial look at the issue. Beesie is one of the resident experts on the boards, and here is the very well thought out post on this topic:

"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!"

The radiation treatments didn’t bother me! My skin held up really well no bad blisters or cracking! It has been the lasting side effects that have caused a problem! The tissue in my breast has tightened... l have lost sensation in some areas and other areas just hurt to touch! Nothing that I couldn’t live with if I had to but since I have the option ... I am going to give it a go! The way that my MO explain it to me is that your surgical decision does not change your survival rate

It is very difficult and very personal. As soon as I found out, I knew what I would do.I had bc in my right breast but opted for A double mastectomy. I was offered a lumpectomy and rads, but with me, I did not want to go through the extra screening. I'm anxiety ridden to begin with plus my sister, who is 6yrs older had battled breast cancer, and I felt that the most I could do for myself was to do a dmx.

My experience with the mastectomy is probably not as common as most. I had very little to no pain. I went straight to implants, due to having very tight skin. PS did not think doing expanders was a good idea nor did I have enough fat anywhere to do DIEP. I also had a nipple sparing mastectomy. They did not offer pain meds and I did not ask. They gave Ketolorac during and after. Heavy duty tylenol is what the nurse said, and that was ok with me. I felt tightness for a few days but i kept stretching.

I was not well endowed in the boob dept so having the implant has given me a more rounded appearance but still a small B. Does it look great? No..I see rippling, but the man in my life never says a word about it. Pays attention to them as much as he did when they were all me. I have some decent sensations back and it has not been a year yet. Don't have to wear a bra, they are perky, looks good in a bra too. I may not be the norm, but I wanted you to know that everyone is different in how they handle, how they feel, how their surgery and recovery goes. Some have a very difficult time, some somewhere in between. I happened to be lucky. I walked out the next day and walked every day since.

I don't regret my decision, it was right for me. Take the time to think about it, talk about it. Fear is a powerful thing. I went with my gut on it. You will come to the right decision for you. Hugs to you during this difficult time.

yes sweetie it is personal choice I was planning my 2nd marriage at 42yrs when found the lump in shower I thought bout lumpectomy but decided on mastectomy so I didn't have to keep worrying I d have to go back for mastectomy I am now a 24 yr Survivor Praise God I count when my treatment finished I was 43. Just celebrated my 67th B D. Praise God. Ms Phil idc 0/3 nodes Lmast 3mo chemo before n after surgery Lmast got married then rads 7wks and 5yrs on Tamoxifen.

That is a decision only you know the answer to. It’s so hard to because yes, once they’re gone, they’re gone. I to am faced with the same decision and due to my “girls” being only A cups and the size of my tumor, I’m leaning towards a mastectomy as I don’t want to have to deal with this again should a reoccurrence happen. My surgeon was amazing in explaining the pros and cons of both surgeries. So I’m confident I will make the right choice and I know you will too.