How to choose the right type of breast cancer surgery
Special to The Island News
For women diagnosed with breast cancer, choosing the right surgical treatment is one of the most important decisions they will make.
While mastectomy was once considered the standard approach for most breast cancers, advances in cancer care have expanded treatment options significantly.
No two breast cancers are exactly alike. Your personalized treatment plan depends on several factors, including:
- Type of breast cancer
- Cancer stage and tumor size
- Whether lymph nodes are involved
- Hormone receptor and HER2 status
- Genetic testing results
- Your overall health and personal preferences
Breast cancer treatment often combines local therapies – such as surgery and radiation therapy – with systemic therapies including chemotherapy, hormone therapy, targeted therapy or immunotherapy.
Together, these treatments aim to remove existing cancer, reduce recurrence risk and improve patient outcomes.
“There is no one-size-fits-all treatment for breast cancer,” explains Dr. Aubrey Place, who performs breast cancer surgery as part of the Beaufort Memorial Breast Care & Surgery Program. “When it comes to my patients, I explain the risks, benefits and expected outcomes of each treatment option so patients can make informed decisions that align with their goals.”
Lumpectomy vs. Mastectomy: What’s the difference?
Lumpectomy (Breast-conserving surgery)
A lumpectomy removes the cancerous tumor along with a small margin of healthy tissue while preserving most of the breast.
Benefits may include:
- Preservation of breast tissue
- Faster recovery
- Less extensive surgery
- Similar survival outcomes to mastectomy for many early-stage breast cancers when combined with radiation therapy
Most women who undergo lumpectomy for DCIS or invasive breast cancer will also receive radiation therapy to lower the risk of local recurrence.
Mastectomy
A mastectomy removes all breast tissue and may be recommended when:
- The tumor is large relative to breast size
- Multiple tumors are present
- Radiation therapy is not an option
- Genetic risk factors increase future cancer risk
- Patient preference favors breast removal
There are several types of mastectomy:
- Total (simple) mastectomy – removes the entire breast and typically results in a flat chest wall closure.
- Skin-sparing mastectomy – removes breast tissue while preserving most of the breast skin, allowing for more natural-looking reconstruction.
- Nipple-sparing mastectomy – preserves the nipple-areola complex in carefully selected patients, improving cosmetic outcomes following reconstruction.
- Modified radical mastectomy – removes the breast and many lymph nodes under the arm when more extensive treatment is needed.
Understanding lymph node surgery
Breast cancer cells can spread through the lymphatic system. To determine whether cancer has reached nearby lymph nodes, surgeons often perform a sentinel lymph node biopsy during surgery.
If cancer is found in those nodes, an axillary lymph node dissection may be recommended to remove additional lymph nodes for treatment and staging purposes.
Accurate lymph node assessment helps guide decisions about radiation, chemotherapy and other treatments.
Is removing both breasts necessary?
Some women diagnosed with cancer in one breast consider a contralateral prophylactic mastectomy, which removes the second, healthy breast to reduce further risk.
Most women with cancer in one breast have a relatively low risk of developing cancer in the opposite breast. The decision to remove the second breast, however, should be based on individual risk factors, family history, genetic testing results and discussions with your breast surgeon.
Historically, many patients believed that more extensive surgery automatically led to better outcomes, but decades of clinical evidence have challenged that assumption.
For many women with early-stage breast cancer, breast-conserving surgery followed by radiation therapy provides surgical outcomes comparable to mastectomy.
A landmark 2022 study published in JAMA Surgery evaluated long-term outcomes among women treated for stage 0-2 breast cancer. Researchers found that women who underwent breast-conserving surgery (compared with some women who underwent mastectomy) reported:
- Better psychosocial well-being
- Better sexual well-being
- High levels of satisfaction with their breasts
- Less long-term treatment regret
Physicians today consider not only cancer control and survival, but also how treatment choices affect physical function, emotional health, body image and overall quality of life.
“Our goal is not simply to treat cancer,” Dr. Place says. “It’s to help every woman achieve the best possible outcome while maintaining her quality of life.”