Dr. Joel Aronowitz - BREAST CANCER AWARENESS - Should I get a LUMPECTOMY or MASTECTOMY? Pros and Cons of Each
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| Dr. Joel Aronowitz |
Joel A. Aronowitz:
Hi everyone!
Want to take
a moment and just talk very briefly about treatment of breast cancer.
Basically, for most breast cancers, it will come down to lumpectomy versus a
mastectomy. And if the breast cancer is small, which fortunately many breast
cancers are nowadays, a lumpectomy may accomplish removal of the breast cancer
with good margins. But that treatment always comes with some adjunct treatment,
some add on treatment.
So if you
have a small breast cancer and the doctor says we want to do breast
conservation, that means basically just taking out the lump and some
surrounding breast tissue and then doing some additional treatment. Typically
that's radiation and sometimes some form of chemotherapy as well. So although
the breast itself is conserved, so to speak, the breast may be disfigured from
the lumpectomy. Depending on how big the breast is and how much tissue is taken
out, there can be some serious contour deformity of the breast that's permanent
and the radiation doesn't help any. The radiation causes a fibrosis which
basically gets worse over the years, not better.
So then you
also have to worry about the additional breast tissue which has been left,
which has already formed one breast cancer and is at risk of forming additional
breast cancer over the course of a woman's lifetime. The alternative is a
mastectomy, which sounds very daunting, but basically it can be accomplished by
simply removing the breast tissue inside the skin envelope, leaving the skin
intact, and then replacing that volume with an implant or with fat grafting, or
with a flap transferred, for example, from the tummy or transferred from the
buttock.
So those
operations get rid of the entire volume of the breast tissue within the breast,
but preserve the skin, including the nipple, and are done through an incision
that is usually underneath the fold of the breast where it hides
inconspicuously. A woman with a large breast can have a breast reduction type
of operation which removes all the breast tissue and then repositions the
nipple and makes the skin envelope more perky before the volume is filled in
with an implant.
So a
mastectomy doesn't have to be disfiguring the way it was in times gone by,
which means an ugly scar across the chest, the nipple, and all the extra skin
is taken and the woman is left with a really horrible deformity. And even with
reconstruction, the appearance is not natural and is not very attractive.
So a woman
can consider a mastectomy and have a very natural, cosmetically, natural
appearing breast. It's important to know that not every woman is a good
candidate for that. But most women are, despite how large or small the breast
is, if the breast cancer doesn't involve the skin itself, which most breast
cancers early on do not.
It's also
important to know that any mastectomy, whether it's an old style modified
radical mastectomy, which is the kind that leaves the oblique scar across the
chest, or the newfangled cosmetically more desirable oncoplastic surgery and
nipple sparing, for example, all of these operations leave some minute amount
of breast tissue somewhere in the neighborhood of 2, 3, 4%, something like
that, of the breast tissue, because you can't get all the breast tissue no
matter what.
So there's
no purity to this in the sense that you're eradicating all breast tissue. That
just doesn't happen. What's happening is you're removing the vast majority of
the breast tissue and in practice that's what is good enough for almost
everybody. If there's a recurrence of breast cancer, it's highly unlikely to be
in that little bit of breast tissue that's under the nipple areola complex.
And we have
good evidence now from big studies that show the recurrence risk of a breast
cancer is the same whether the mastectomy was done with a more modern nipple
sparing technique or more old fashioned modified radical mastectomy.
So there you
have it, kind of the pros and cons of doing lumpectomy with some adjunct
chemotherapy and radiation versus a mastectomy, which usually does not require
adjunct radiation or chemotherapy for most women. It's also important to point
out that most of the time both of these options are going to include sampling
the lymph node on the same side as the breast cancer. And that sampling is
called a sentinel node biopsy.
Basically,
the doctor will inject a little bit of dye near where the breast cancer is and
then go to the lymph node that that dye appears in. Initially figuring that if
any of the lymph nodes under the arm are going to be positive for breast
cancer, it's going to be the one that is closest. So that's called a sentinel
node biopsy, and usually that's going to be recommended whether you have a
lumpectomy and radiation, a so called breast conservation approach, or a
modified radical mastectomy or more modern oncoplastic nipple sparing type mastectomy.
So hope that
helps, hope it clarifies things for you and doesn't make it more confusing. You
can go to the nonprofit website Breast Preservation Foundation for more
details. And there are some videos that may explain things better. Just
watching the video, be careful. There's some more graphic videos, so if you
don't like surgery, probably don't click on those and you can always email us
and we'll do our best to point you in the right direction. So hope that helps.
And more later. Direct from Aronowitzland.
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