Assessing treatment options after a breast cancer diagnosis

Question: I understand surgery is often included as part of the treatment plan for breast cancer. If I’m a candidate for lumpectomy but am also considering a mastectomy, what are some things I should keep in mind? Should my breast density be a factor in my decision-making?

Answer: Women diagnosed with breast cancer are almost immediately confronted with treatment decisions. If your surgical oncologist gave you a choice between a lumpectomy and a mastectomy to remove a tumor, that’s often because either option will lead to a similar long-term health outcome.

A lumpectomy is commonly known as breast conservation surgery because it keeps most of the breast intact, whereas a mastectomy removes the entire breast. Regardless of which procedure you choose, the risk of breast cancer recurrence is roughly the same.

Lumpectomy is a treatment option for early stage breast cancer. Compared with a mastectomy, it’s less invasive and tends to have a quicker recovery. It also can help preserve the cosmetic appearance and sensation of the breast. Your health care professional will recommend radiation therapy after a lumpectomy to reduce the risk of breast cancer returning in the breast.

A mastectomy removes the whole breast. In many cases, radiation therapy is not needed after mastectomy. Individuals with a genetic predisposition for breast cancer, such as the BRCA1 or BRCA2 gene mutation, may opt for a mastectomy as a preventive measure following their diagnosis.

After a mastectomy, some women choose to forgo reconstructive surgery, opting for what is called an aesthetic flat closure. There can be many reasons for this, including wanting to limit future surgeries, reducing risks and complications, and desiring a faster return to daily life and activities.

For other patients, having a breast mound is part of how they identify as women. Multiple types of breast reconstruction procedures are available following either a lumpectomy or mastectomy. Breast reconstruction surgery can occur at the same time as breast cancer surgery, or you can plan your reconstruction weeks, months or years after treatment.

The surgical technique and cosmetic outcomes after mastectomy and reconstruction have improved over the past 20 years. More women can keep their nipple and areolar complex, and in many cases, a procedure can be performed to help improve sensation to that area.

Breast density also could be a factor in your decision-making. About half of the people who have screening mammograms have dense breasts. Dense breast tissue is harder to see through on a mammogram image. Having dense breast tissue should not affect one’s decision to undergo a mastectomy or lumpectomy.

However, dense breast tissue might influence the need for additional tests before surgery, such as an MRI. An MRI looks for abnormal blood flow within the breast and can “see through” dense tissue. This might help surgeons better determine the extent of disease and guide them in the removal.

Ultimately, determining the option that is best for you is a nuanced decision that can be based on a variety of factors, including cancer-based reasons, family history and genetics, and peace of mind.

Choosing which surgical route to take is deeply personal, and there is no one “best choice” for every woman. After careful consideration and consultation with your health care team, you should make the decision that you determine is best for you, based on the specifics of your cancer and your individual needs and preferences.

Dr. Sarah McLaughlin is a surgical oncologist with the Mayo Clinic in Jacksonville, Florida.