Breast Cancer Surgery: How To Decide Whether To Have Breast Conserving Surgery vs Mastectomy
I have often been asked by patients if they are a candidate for breast conservation surgery or should they have a mastectomy. So is there a right answer?
Both you as a patient and your surgeon have a say in this decision, but ultimately the choice is yours.
Surgeons decision
The breast surgeon will decide whether it is possible to perform the breast-conserving surgery or if the mastectomy is required. How do we as surgeons do this?
This decision will depend on the amount of breast tissue that will need to be removed and in which part of the breast the cancer is vs the amount of breast tissue (size of the breast) that the woman has.
When we are talking about the outside half of the breast (towards the armpit), we can remove up to 20% of breast tissue. In the middle half of the breast, you can only remove 15% of the whole breast tissue. This is, so we prevent deformity of the breast following surgery and likely radiation afterwards.
As surgeons, we aim to remove cancer or the calcifications (usually DCIS) and 1 cm of normal breast tissue around a tumour. So if a tumour is 1 cm in diameter, approximately 3 cm in diameter of breast tissue will be removed. If a tumour is 3 cm in diameter, then 5 cm in diameter of breast tissue will be removed.
After the cancer is removed, the breast tissue around the cavity is moved to fill in the cavity. If tissue from a different part of the body is used - this is called a flap.
So please talk to your surgeon whether or not she or he is able to perform breast-conserving surgery.
Your decision
Your surgeon will let you know if she or he can technically perform breast-conserving surgery. If this is possible, then it's your decision whether or not you would like to have breast-conserving surgery.
The risk of cancer coming back over time in the same breast is similar whether you have a mastectomy (removal of the whole breast) or breast-conserving surgery followed by radiation. The risks associated with mastectomy and breast-conserving surgery are similar (apart from the risk of positive margins) and not very high at all. But do discuss these risks with your surgeon, as these do differ between different surgeons. If you do have breast reconstruction at the same time as a mastectomy, then the surgical risks are much higher.
In women with low risk of breast cancer (general population), there is no need to remove another breast to prevent cancer on that side. The risk of cancer in the other breast causing risks to your life is less than 1%. The risks of surgery are higher.
You and your surgeon need to have a discussion about whether the breast-conserving surgery is technically possible. Risks of both surgeries, as well as recurrence, need to discuss so you can make an informed decision with regards to the operation. In the end, it's your decision about which surgery you will have.
Please do not rush with this decision, take your time. Short delays do not have any impact on your survival, but making a decision that you are not happy with will have an impact on you