Under certain circumstances, people with breast cancer may the opportunity to choose between total removal of a breast (mastectomy) and breast-conserving surgery (lumpectomy) followed by radiation.
Lumpectomy
Lumpectomy followed by radiation is likely to be equally as effective as mastectomy for people with only one site of cancer in the breast and a tumor under 4 centimeters. Clear margins are also a requirement (no cancer cells in the tissue surrounding the tumor).
Advantages:
The main advantage of lumpectomy is that it can preserve much of the appearance and sensation of your breast. It is a less invasive surgery, so your recovery time is shorter and easier than with mastectomy.
Challenges:
You are likely to have 5 to 7 weeks of radiation therapy, 5 days per week, after lumpectomy surgery to make sure the cancer is gone.
Radiation therapy may affect the timing of reconstruction and possibly your reconstruction options after surgery. Radiation therapy also may affect your options for later surgery to lift or balance your breasts.
There is a somewhat higher risk of developing a local recurrence of the cancer after lumpectomy than after mastectomy. However, local recurrence can be treated successfully with mastectomy.
The breast cannot safely tolerate additional radiation if there is a recurrence in the same breast after lumpectomy. This is true for either a recurrence of the same cancer, or for a new cancer. If you have a second cancer in the same breast, your doctor will usually recommend that you have a mastectomy.
You may need to have one or more additional surgeries after your initial lumpectomy.
Mastectomy
Mastectomy (total/simple) involves removal of all of the breast tissue. The muscle on the chest wall is not removed. Removal of the breast causes the breast skin to lose sensation. Mastectomy techniques may vary depending on the size and shape of your breast and the location of your cancer. In some cases, the nipple can be spared (nipple-sparing mastectomy). In most cases, sentinal lymph node dissection and lymph node dissection, if indicated, is performed at the same time as the mastectomy.
Skin Sparing Mastectomy
With this technique, the inner breast tissue and nipple are removed, but the skin is maintained. This usually results in a scar that runs from the previous location of your nipple out towards the armpit.
Reconstruction would also take place through this scar. Depending on the type of reconstruction you have, the location or appearance of your scar may change.
Nipple Sparing Mastectomy
For certain women with small cancers, or cancers that are far enough away from the nipple, the nipple can be spared. Although the nipple will not have normal sensation, this can result in a more natural appearing breast reconstruction. Nipple-sparing mastectomy also reduces the number of surgeries needed to complete reconstruction. Scars may vary, but most commonly the scar is located in the crease at the bottom of the breast, which is easier to hide.
Radical mastectomy
In a radical modified mastectomy the entire breast is removed including the skin, nipple, areola, the lining over the chest muscle and the lymph nodes under the armpit. The chest muscle itself is not removed.
Bilateral mastectomy
Bilateral risk-reducing mastectomy (or previously called prophylactic mastectomy) refers to mastectomy before a cancer has been found. It is a risk-reducing surgery rather than a prophylactic procedure as even after the mastectomy a small percentage of breast tissue is left, which still bears the risk of developing cancer. The reason for that is that the breast tissue does not sit in a well-defined shell like the kidney or the liver.
In August 2015, I received a radical bilateral mastectomy with reconstruction.
Any questions on the type of surgery and reconstruction I had, please reach out to Lauren@LivandLet.com