Q&A Topic: Lumpectomy v. Mastectomy

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Anthony C. Cahan, MD FACS

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Q. If I have the option between a lumpectomy or a mastectomy, how do I choose?

A. This really involves two questions: The medical and the personal. For the medical question, the first judgment is whether the tumor can be removed with a rim of noninvolved surrounding breast tissue, which we call “margins.” It’s necessary to have clear margins. As long as there are even microscopic margins, and enough tissue left to reconstruct the breast with an acceptable aesthetic result, you should be fine. It’s important to keep in mind that at least seven large international studies have shown that women randomized between those who received lumpectomies and mastectomies have equal survival rates.The personal question relates to the radiation treatments that are almost always required with a lumpectomy. Many patients do not want to undergo radiation in addition to the surgery or they do not have the time for the treatments that are needed five out of seven days for three to six weeks. Some patients also have certain medical conditions, such as cardiovascular issues, diabetic issues, or heart issues that are contraindicated, that prevent them from having radiation treatments.

Q. What are the most important questions to ask when deciding between a lumpectomy or a mastectomy?

A. You should first ask yourself: How concerned are you about follow up? Patients who don’t want to go for screenings, such as mammograms, or are too anxious to have follow-up procedures will often choose the mastectomy.I also ask patients: Where do you want to be five, 10, 15 years from now? Are you able to tolerate the possibility of the tumor returning in the breast? The chance of it returning is higher in lumpectomy than in mastectomy, even though that does not translate into a survival detriment. With a lumpectomy, the chance of a tumor returning is between 10 and 15 percent. With a mastectomy, there is a four to five percent chance of the tumor coming back.In addition, I advise patients to ask: If I’m opting for a mastectomy, what kind of a mastectomy is possible? The most common today are skin sparing or nipple-sparing mastectomies.

Q. How do I know if I’m a candidate for those procedures?

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A. Any patient whose tumor does not directly involve the skin should be a candidate for a skin sparing mastectomy. As a rule of thumb, any patient whose tumor is 3 cm or more from the nipple should be a candidate as well for the nipple-sparing mastectomy. Both of these procedures, however, require immediate reconstruction by a reconstructive surgeon.

Q. What should I look for in a breast surgery program?

A. It’s important to look for a program that offers a multidisciplinary approach to your cancer treatment. That’s approach we take at Northern Westchester Hospital. We have weekly meetings of the entire Breast Cancer group to discuss difficult or challenging cases. The multidisciplinary plans include breast cancer surgeons, reconstructive surgeons, medical oncologists, dedicated breast imagers, pathologists, genetic counselors, radiation oncologists, and of course, dedicated nursing staff.

Anthony C. Cahan, MD FACS, has been Chief of Breast Surgical Services for The Breast Institute at Northern Westchester Hospital since 2002. His previous experience includes an internship and residency in general surgery at The New York Hospital-Cornell University Medical College, and cancer studies at Memorial Sloan-Kettering Cancer Center and Beth Israel Hospital.

Northern Westchester Hospital
Chief of Breast Surgical Services, The Breast Institute at Northern Westchester Hospital
Learn More About Dr. Cahan

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Northern Westchester Hospital is a proud member of Northwell Health (formerly North Shore-LIJ Health System).

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