You may still be absorbing the news that you have breast cancer – and now there are decisions to make about treating it.
We’re here to guide you through those decisions, answer your questions, address your fears and help you decide how to proceed.
Some women feel like they want everything to slow down so they can take a breath and work out how to proceed. Others want to get on with treatment as soon as possible.
As the Cancer Council notes, treatment for early or locally advanced breast cancer usually includes surgery. The first step in making any decision is to ensure you’re fully informed. So let’s take a look at the two options for breast cancer surgery.
Mastectomy
A mastectomy is a breast cancer surgery that removes the whole breast and is performed either to treat or prevent breast cancer. It may be followed by reconstructive surgery, or you may choose to ‘go flat’ or wear a prosthesis in your bra to balance your shape.
Mastectomy has a long history. It was first offered in the 1800s and was the only treatment for breast cancer until the 1970s. Since then, we’ve developed variations on the initial procedure and we’ve developed alternatives such as breast-conserving surgery, which we’ll cover below.
There are now several different mastectomy procedures. Exactly which one suits you best depends on factors such as:
- Your family history
- The size and location of your tumour
- Your breast size
- Whether your cancer has spread to your lymph nodes or chest wall
- Whether you’re planning a breast reconstruction – if so, you may be able to have a nipple-sparing or skin-sparing mastectomy followed by breast reconstruction either in the same surgery or at a later date
- Your overall health
- More than one cancer in different parts of the breast
- Previous breast radiation.
Pros of mastectomy
You might lean towards a mastectomy if you:
- Just want to ‘get it over and done with’
- You’ve had previous lumpectomies but your surgeon couldn’t get clear margins
- Have cancer in many different parts of your breast
- Carry the BRCA1 or BRCA2 genes
- Can’t have radiotherapy due to your medical history or a current pregnancy
- Would have to travel a long way for radiotherapy
- Think you might have more peace of mind afterwards
- Want to avoid the need for annual mammograms because you know you’d feel too anxious.
Cons of mastectomy
On the downside, mastectomy:
- Means the permanent removal of your breast, including the loss of healthy tissues
- Potentially affects your body image or sense of femininity
- May require a second operation if you want to have breast reconstruction as this can’t always be done at the same time.
Breast-conserving surgery
Breast-conserving surgery (also known as lumpectomy or wide local excision) involves surgically removing only the tumour and some of the healthy tissue around it. It’s usually followed by radiotherapy to destroy any cancer cells that may be left in your breast or armpit.
Breast-conserving surgery can be a good option for early stage breast cancer, where the cancer is not too large in comparison to the breast and has not invaded the surrounding tissues.
Pros of breast-conserving surgery
Breast-conserving surgery may be a good option if you:
- Are keen to retain sensation and quality of life
- Want a less disruptive surgery that preserves as much of your breast as possible
- Are willing and able to access radiotherapy afterwards
- Have a chronic illness like diabetes that may mean a smaller surgery is advisable
- Are happy to go for annual mammograms and don’t feel too anxious about the results.
Cons of breast-conserving surgery
The main cons of breast-conserving surgery are:
- The possibility of a repeat procedure or a mastectomy if your histopathology results show that the margins (healthy tissue around the tumour) are not satisfactory
- The need for radiotherapy afterwards
- Yearly mammograms and ultrasounds, in some cases causing anxiety.
What’s involved in radiotherapy?
As you can see, one key difference between these surgeries is that breast-conserving surgery requires radiotherapy afterwards whereas mastectomy doesn’t.
Radiotherapy usually starts about 8 weeks after your surgery and is a repeated treatment. You’d usually need to go to hospital daily for 3-6 weeks and receive treatment as an outpatient. The treatment itself isn’t painful but it does take time out of each day and it can cause a range of side effects.
Is radiotherapy scary? Half of the women in one 2017 survey reported that they had heard or read frightening stories about radiation therapy, and more than 90% were initially fearful of undergoing radiotherapy.
Once they’d experienced radiotherapy, though, 90% of those patients said it was ‘less scary’ than they anticipated. That was true not just of the procedure itself but of the short-term and long-term side effects.
So, don’t let fear of radiotherapy put you off breast-conserving surgery if that’s your real preference.
Which surgery has better results?
That’s one of the most common – and most important – questions that patients and families ask.
The reassuring answer is that, according to current evidence, both surgeries are as effective as the other. Over a 10-year period, studies indicate that there is no difference in long-term outcomes between mastectomy and breast-conserving surgery.
The Cancer Council states that,
Research has shown that for most early breast cancer, having breast-conserving surgery followed by radiation therapy works just as well as a mastectomy. The chance of the cancer coming back in another part of the body is the same for both types of surgery. The operations have different benefits, risks and side effects.
The case for breast-conserving surgery seems to be strengthening. A 2021 study showed that women who have had breast-conserving surgery had lower rates of local, regional and distant disease recurrences.
Back in 2016, Edinburgh researchers argued that, if you’re eligible for breast-conserving surgery, you should have it because it offers at least equivalent survival and recurrence rates (compared to mastectomy) while also delivering ‘the advantages of fewer complications, better quality of life and many fewer operations if reconstructive surgery is performed.’
What’s the right answer for me?
Sometimes, there’ll be a clear clinical need for you to have one surgery or the other. In such cases, we’d urge you to follow your surgeon’s advice.
Often, though, there isn’t a clear right answer. You have the choice and it depends on many personal factors.
You may want to ask yourself how you feel about having:
- A whole breast removed versus having only part of it removed
- Breast reconstruction after mastectomy (possibly in a second procedure) or wearing a breast prosthesis
- Oncoplastic surgery where your tumour is removed and your breast reconstructed in the same surgery
- A course of radiotherapy.
If you’re not sure which way to go, then ask your surgeon:
- Whether you can take more time to decide
- For more information, particularly about the issues that may sway your decision one way or the other.
How Gault Surgery can help
Dr John Gault is a surgeon at the forefront of the developing field of oncoplastic surgery, a combination of breast cancer surgery and plastic surgery that incorporates advanced surgical techniques to achieve the best oncological and aesthetic outcome after breast surgery. He has fulfilled the training requirements set by BreastSurgANZ to perform oncoplastic and reconstructive techniques and continues to keep his skills up to date. Dr Gault has also been involved in training and teaching junior surgeons in oncoplastic and reconstructive skills and techniques for the past 10 years.
At Gault Surgery, we value personal and individualised care over a ‘one size fits all’ solution. Our goal is for you to feel heard, comfortable and understood. Dr Gault, and our breast cancer nurse, Julie, are here to provide all the information and support you need to help you decide on your preferred treatment option for breast cancer surgery.
Gault Surgery delivers care through a patient-centred multidisciplinary team that draws on the expertise of a medical oncologist, radiation oncologist, radiologist, pathologist, breast care nurse, physiotherapist and an oncology psychologist.
Please contact us today.
Disclaimer
All information is general and is not intended to be a substitute for professional medical advice. Gault Surgery can consult with you to confirm if a particular treatment is right for you. Any surgical or invasive procedure carries risks. A second opinion may help you decide about your treatment options.