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Can you tell me about the benefits and risks of mastectomy compared to lumpectomy and radiation?
- Anna(AI First Responder)••Verified by Curio clinician
Mastectomy and lumpectomy are both surgical treatments for breast cancer, but they vary in the extent of tissue removal and their potential benefits and risks.
Mastectomy is a surgery designed for the removal of all breast tissue, from the breast, nipple, and areola to the sentinel lymph node or nodes. This procedure is usually indicated for patients with multiple or large areas of ductal carcinoma in situ or non-invasive breast cancer, and for some stage I and stage II (early stage) breast cancers. A mastectomy is usually indicated for stage III (locally advanced) breast cancer in combination with chemotherapy, and for inflammatory breast cancer with chemotherapy, Paget’s disease of the breast, or locally recurrent breast cancer. The surgery reduces the risk of cancer recurrence to between 1% and 3%. However, it has risks such as bleeding, infection, pain, swelling (lymphedema) in the arm, formation of hard scar tissue at the surgical site, shoulder pain and stiffness, numbness — particularly under the arm — from lymph node removal, and buildup of blood in the surgical site (hematoma). A major disadvantage is that a mastectomy is permanent and you cannot replace the natural breast. Even with modern plastic surgical techniques, the breast and nipple lose sensation (become numb) after mastectomy. Mastectomy with reconstruction has been associated with a 30% to 50% complication rate, including infection, poor healing, unplanned return to the operating room, implant problems, and more.
On the other hand, a lumpectomy involves removing the cancer and some of the healthy tissue that surrounds it, and is also referred to as breast-conserving surgery or wide local excision. Lumpectomy is a treatment option for early-stage breast cancer and is usually followed by radiation therapy to the breast to reduce the chances of cancer returning. The goal of lumpectomy is to remove cancer or other abnormal tissue while maintaining the appearance of your breast. Studies indicate that lumpectomy followed by radiation therapy is as effective in preventing a recurrence of breast cancer as removal of the entire breast (mastectomy) for early-stage breast cancer. However, there are situations where lumpectomy may not be recommended, such as if you have a history of certain diseases that could make healing after lumpectomy difficult or worsen with radiation treatments, have two or more tumors in different quadrants of your breast, have previously had radiation treatment to the breast region, have cancer that has spread throughout your breast and overlying skin, have a large tumor and small breasts, or do not have access to radiation therapy. Lumpectomy also carries risks of bleeding, infection, pain, temporary swelling, tenderness, formation of hard scar tissue at the surgical site, and change in the shape and appearance of the breast, particularly if a large portion is removed.
- Hillary Lin(Physician)•
Depending on your stage of breast cancer, it may be beneficial to pursue a mastectomy vs a lumpectomy, and vice versa. The reason is that for earlier-stage tumors, recovery is faster and the patient can undergo systemic treatments like chemo earlier after the surgery if one gets a lumpectomy. But for later-stage tumors, the risk of recurrence and spread is higher so a mastectomy is more beneficial for outcomes and survival.