Surgical Options in Breast Cancer: Mastectomy vs. Lumpectomy

Breast cancer treatment has evolved significantly over the years, with advancements in imaging, chemotherapy, radiation, and targeted therapies. Today, breast cancer patients benefit from a multidisciplinary approach, where a team of doctors, including surgical oncologists, medical oncologists, radiation specialists, and others, collaborate to create personalized treatment plans. When it comes to surgery, the two main options are mastectomy and lumpectomy (breast conservation surgery), each offering its own benefits and considerations.

Dr. Naveen Sanchety, Director of Surgical Oncology,  Sarvodaya Hospital, Sector-8, Faridabad, explains, “Breast conservation surgery is usually the preferred option for patients with early-stage breast cancer because it allows for the removal of the tumor while preserving most of the breast. However, many patients opt for mastectomy due to fear of recurrence. That said, breast conservation remains a valid option for those who prioritize preserving their breast to maintain their body image.”

Breast Conservation vs. Mastectomy: Key Differences

A lumpectomy, also known as breast-conserving surgery, involves removing only the tumor and a small margin of surrounding tissue, while leaving the majority of the breast intact. Dr. Rajeev Agarwal, Senior Director of Cancer Care at Medanta, Gurugram, notes, “Lumpectomy is ideal for patients who have smaller tumors, as it offers the same long-term survival rates as mastectomy when combined with radiation therapy. However, the choice between lumpectomy and mastectomy depends on several factors, including the size and location of the tumor, as well as patient preference.”

Mastectomy, on the other hand, involves the removal of the entire breast. While this approach might seem more radical, some patients choose it to reduce the risk of recurrence, particularly if they have genetic predispositions to breast cancer or larger tumors. “Patients with large tumors in small breasts may not be good candidates for lumpectomy because it would be difficult to remove the tumor without significantly altering the breast’s appearance,” explains Dr. Agarwal. “Conversely, those with larger breasts may be better suited for breast-conserving surgery, even with similar tumor sizes.”

Psychological and Physical Impact of Surgery

The psychological and emotional impact of the surgery choice is a crucial consideration for many patients. According to Dr. Sanchety, “Patients who undergo mastectomy tend to take longer to adjust to their new body image. They often report lower self-esteem and slower recovery compared to those who opt for breast conservation surgery.” This is largely because breast conservation surgery allows patients to retain their natural breast, which contributes to a better self-body image and overall quality of life.

In fact, studies show that patients who choose breast conservation surgery often experience improved sexual functioning, fewer wound-related issues, and a better systemic side-effect profile after chemotherapy. “Those who undergo breast conservation surgery tend to have better psychological outcomes, improved quality of life, and similar survival rates compared to mastectomy,” adds Dr. Sanchety.

Suitability and Contraindications for Breast Conservation

While breast conservation surgery is a highly desirable option for many women, it is not suitable for everyone. “Certain contraindications make mastectomy the only safe choice,” says Dr. Sanchety. These contraindications include pregnancy, multicentric tumors, diffuse malignant microcalcifications, inflammatory breast cancer, genetic predispositions, previous radiation therapy, and autoimmune diseases. “For these patients, mastectomy is often recommended to ensure the best oncological outcomes.”

Ultimately, both surgical options offer similar survival rates when combined with appropriate follow-up treatments like chemotherapy and radiation. “The decision between mastectomy and lumpectomy should be made after considering all factors, including the patient’s values, medical history, and preferences,” says Dr. Agarwal. He emphasizes that both options are effective at removing cancer, and the choice should reflect what is best for the patient’s long-term health and emotional well-being.

Choosing between mastectomy and lumpectomy is a deeply personal decision for breast cancer patients. While mastectomy may offer peace of mind for those concerned about recurrence, breast conservation surgery provides the benefit of preserving body image and self-esteem. Dr. Sanchety and Dr. Agarwal agree that every patient’s case is unique, and the decision should be made in consultation with a multidisciplinary team of specialists, ensuring the best individualized treatment plan based on the patient’s specific needs and preferences.