Weighing lumpectomy versus mastectomy

A mastectomy may be indicated medically if:

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• Two or more tumors exist in different quadrants of the breast (a "multifocal" cancer).
• DCIS is distributed throughout the breast.
• The breast has previously received radiation treatment.
• The cancer is large compared with the size of the breast.
• The patient has had scleroderma or another disease of the connective tissue, which can complicate radiation treatment.
• The patient is in the first or second trimester of pregnancy and cannot have radiation because of the risk to the fetus.

However, in many cases, a woman's doctors may feel that both procedures are reasonable from a medical point of view. Women with early-stage cancer especially may be presented with both options. As women struggle with choosing between the two they should bear mind that there is no "correct" choice and that what feels right to one woman may not feel right to another in a seemingly similar situation. Below are some factors to consider when making the choice:

• The importance to the woman of preserving her breast. Some women fear they will feel disfigured by the complete removal of a breast. Others are concerned that their intimate relationship will suffer if their breast isn't preserved. Especially when a woman's breasts are big and the tumor is small, a lumpectomy may permit enough of the breast to be conserved that its appearance, when healing is complete, will be close to what it was before the surgery.
• Concerns about recurrence. Women who have had breast cancer are at an elevated risk of having a recurrence in that same breast. Some women may choose mastectomy in part because it lowers their risk of this kind of a "local recurrence." However, with close surveillance and regular checkups it is likely that a recurring cancer would be detected before it became life threatening.
• Concerns about radiation. Mastectomy has the advantage of generally not requiring radiation treatment, which slightly increases your risk of a new tumor and, in a small percentage of patients, causes damage to the heart or lungs. Although the risk of these complications is very small with newer techniques for delivering radiation, some women may have more concerns about those risks than they do about losing a breast.
• Concerns about a feeling of imbalance after mastectomy. Some women worry that they will feel uneven after a mastectomy. Women who have had the procedure, however, typically report that using a prosthesis inside the bra or breast reconstruction with a silicone or saline implant ameliorates this problem.
• Concerns about lingering symptoms. Following mastectomy, some women find that the tissue around the scar remains numb.