What to Consider when Facing a Breast Surgery Choice: Mastectomy

Women with more than one tumor in the affected breast are usually not candidates for breast-conserving surgery. This is especially true if the tumors are in different areas of the breast. Mastectomy may be recommended in this case.

Tumor Size

The size of the tumor will affect the treatment you receive. For tumors more than 2 centimeters, and for tumors over 5 centimeters that cannot be shrunk by neoadjuvant chemotherapy, mastectomy may be the most appropriate treatment.

Breast Size

The size of your breast, relative to the size of the tumor, will contribute to your surgical choice. Removing a larger tumor from a smaller breast may result in too much tissue being removed, and the breast will not keep its original shape and appearance. Mastectomy may be recommended in this case.

Family History

Your risk of contralateral breast cancer, or cancer in the opposite breast, is somewhat increased by a family history of breast cancer. Some women may choose to have a prophylactic mastectomy on the other breast at the time of the cancer surgery.

Pregnancy

Breast-conserving surgery is usually followed by a course of radiation therapy. If you are pregnant and the timing of surgery means you would have radiation therapy during your pregnancy, then mastectomy may be the recommended choice. Exposure to radiation therapy is not safe for an unborn baby.

Previous Radiation Therapy

Women who previously have had radiation therapy to their chest area or to the affected breast are usually not candidates for breast-conserving surgery because of the inclusion of additional radiation in the treatment plan. Mastectomy may be the recommended option. Discuss this consideration with your doctor.

Some chronic health problems may require special management during or after surgery.

Diabetes

Women who have diabetes usually heal more slowly and are prone to more infections, which can result in postsurgical complications. Careful management of your diabetes during surgery and recovery is needed.

Heart/Lung Disease

If you have a history of heart or lung disease, special care will be needed during and after surgery to manage the increased risk of complications the disease may cause.

Collagen Vascular Disease

Patients with scleroderma, systemic lupus erythematosus, rheumatoid arthritis, or any other collagen vascular disease may experience an enhanced reaction to radiation and may not heal as well. Radiation is an integral part of breast-conserving surgery, but is usually not needed after mastectomy.